Geerdink Thijs H, Salentijn Dorien A, de Vries Kristin A, Noordman Philou C W, van Dongen Johanna M, Haverlag Robert, Goslings J Carel, van Veen Ruben N
Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands.
Department of Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.
Trauma Surg Acute Care Open. 2021 Oct 4;6(1):e000691. doi: 10.1136/tsaco-2021-000691. eCollection 2021.
Guidelines concerning outpatient management of patients during the coronavirus pandemic required minimized face-to-face follow-up and increased remote care. In response, we established a virtual fracture clinic (VFC) review for emergency department (ED) patients with musculoskeletal injuries, meaning patients are reviewed 'virtually' the next workday by a multidisciplinary team, instead of routine referral for face-to-face fracture clinic review. Patients wait at home and are contacted afterwards to discuss treatment. Based on VFC review, patients with minor injuries are discharged, while for other patients an extensive treatment plan is documented using injury-specific care pathways. Additionally, we established an ED orthopedic trauma fast-track to reduce waiting time. This study aimed to evaluate the extent to which our workflow supported adherence to national coronavirus-related guidelines and effects on ED waiting time.
A closed-loop audit was performed during two 4-week periods using predefined standards: (1) all eligible ED orthopedic trauma patients are referred for VFC review; (2) reached afterwards; and follow-up is (3) patient initiated, or (4) performed remotely, whenever possible. Total ED waiting time, time to review, time for review, and time after review were assessed during both audit periods and compared with previous measurements.
During both audits, the majority of eligible ED patients were referred for VFC review (1st: n=162 (88.0%); 2nd: n=302 (98.4%)), and reached afterwards (1st: 98.1%; 2nd: 99.0%). Of all referred patients, 17.9% and 13.6% were discharged 'virtually' during first and second audits, respectively, while 45.0% and 41.1% of scheduled follow-up appointments were remote. Median total ED waiting time was reduced (1st: -36 minutes (p<0.001); 2nd: -33 minutes (p<0.001)). During the second audit, median ED time to review was reduced by -13 minutes (p<0.001), as well as time for review: -10 minutes (p=0.019).
In line with national guidelines, our VFC review allowed time-effective review and triage of the majority of ED orthopedic trauma patients, supporting patient-initiated and remote follow-up, whenever possible. ED waiting time was reduced after implementing the VFC review and orthopedic trauma fast-track.
IV.
关于新冠疫情期间门诊患者管理的指南要求尽量减少面对面随访并增加远程护理。作为回应，我们为急诊科（ED）肌肉骨骼损伤患者建立了虚拟骨折诊所（VFC）评估，即患者在接下来的工作日由多学科团队进行“虚拟”评估，而不是常规转诊至面对面的骨折诊所评估。患者在家等待，之后会接到联系以讨论治疗方案。根据VFC评估，轻伤患者可出院，而其他患者则使用特定损伤护理路径记录详细的治疗计划。此外，我们还建立了急诊科骨科创伤快速通道以减少等待时间。本研究旨在评估我们的工作流程在多大程度上支持遵守国家新冠相关指南以及对急诊科等待时间的影响。
在两个为期4周的时间段内进行了闭环审核，采用预定义标准：（1）所有符合条件的急诊科骨科创伤患者均被转诊进行VFC评估；（2）之后能联系到患者；并且随访是（3）患者发起的，或者（4）尽可能远程进行。在两个审核期间评估了急诊科总等待时间、评估时间、评估时长以及评估后的时间，并与之前的测量结果进行比较。
在两次审核期间，大多数符合条件的急诊科患者都被转诊进行VFC评估（第一次：n = 162（88.0%）；第二次：n = 302（98.4%）），并且之后能联系到患者（第一次：98.1%；第二次：99.0%）。在所有被转诊的患者中，第一次和第二次审核期间分别有17.9%和13.6%的患者“虚拟”出院，而预定随访预约中有45.0%和41.1%是远程进行的。急诊科总等待时间中位数有所减少（第一次：-36分钟（p < 0.001）；第二次：-33分钟（p < 0.001））。在第二次审核期间，急诊科评估时间中位数减少了-13分钟（p < 0.001），评估时长也减少了：-10分钟（p = 0.019）。
符合国家指南，我们的VFC评估允许对大多数急诊科骨科创伤患者进行高效评估和分诊，尽可能支持患者发起的和远程随访。实施VFC评估和骨科创伤快速通道后，急诊科等待时间减少。
IV级。
