Physiotherapist trauma and Orthopaedic Department, Princess Royal Hospital, United Kingdom.
J Ayub Med Coll Abbottabad. 2022 Apr-Jun;34(2):341-344. doi: 10.55519/JAMC-02-9891.
Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety.
A protocol was developed by the clinical team in collaboration with Advanced Physiotherapy Practitioners (APP) on how to manage common musculoskeletal presentations to A&E prior to COVID as part of routine service development. Patients broadly triaged into 4 categories; discharge with advice, referral to VFC, referral to face to face clinic or discussion with on call team. The first 9 months of data were analysed to assess types of injury seen and outcomes.
In total 2489 patients were referred to VFC from internal and external sources. Seven hundred and thirty-four patients were discharged without follow-up and 182 patients were discharged for physiotherapy review. Only 3 patients required admission. Regarding follow-ups, 431 patients had a virtual follow-up while 1036 of patients required further face to face follow up. Eighty-seven patients were triaged into subspecialty clinics. Thirty-seven patients were felt to have been referred inappropriately.
British Orthopaedic Association guidelines suggest all patients need to be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review; the remaining patients were appropriately followed up. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient as well as make the most of the resources available.
虚拟骨折门诊（VFC）已被证明是一种安全且具有成本效益的管理方法，可以处理骨科门诊的转介。在冠状病毒大流行期间，人们一直致力于减少不必要的患者接触，同时保持患者安全。
临床团队与高级物理治疗师（APP）合作制定了一项管理常规服务开发前 A&E 常见肌肉骨骼表现的方案，这些方案包括 COVID 前管理流程。患者大致分为 4 类；根据建议出院、转至 VFC、转至面对面诊所或与随叫随到的团队讨论。分析了前 9 个月的数据，以评估所看到的损伤类型和结果。
共有 2489 名患者从内部和外部来源被转至 VFC。734 名患者未经随访出院，182 名患者出院进行物理治疗复查。仅 3 名患者需要入院。关于随访，431 名患者进行了虚拟随访，而 1036 名患者需要进一步进行面对面随访。87 名患者被分诊至专科诊所。37 名患者被认为转诊不当。
英国骨科协会指南建议所有患者都需要在骨科损伤后 72 小时内进行复查。实施 VFC 可实现这一目标，同时减少患者接触。VFC 审查后，近一半的患者出院；其余患者得到了适当的随访。这在当前大流行期间尤为重要，因为减少不必要的医院就诊将使患者受益，并充分利用现有的资源。
