Hutchison Anne-Marie, Bodger Owen, Whelan Rhys, Russell I Dougie, Man Wing, Williams Paul, Bebbington Andrew
Swansea Bay University Health Board, Port Talbot, UK.
School of Medicine Swansea University, Swansea, UK.
Bone Jt Open. 2022 Sep;3(9):726-732. doi: 10.1302/2633-1462.39.BJO-2022-0077.R1.
We introduced a self-care pathway for minimally displaced distal radius fractures, which involved the patient being discharged from a Virtual Fracture Clinic (VFC) without a physical review and being provided with written instructions on how to remove their own cast or splint at home, plus advice on exercises and return to function.
All patients managed via this protocol between March and October 2020 were contacted by a medical secretary at a minimum of six months post-injury. The patients were asked to complete the Patient-Rated Wrist Evaluation (PRWE), a satisfaction questionnaire, advise if they had required surgery and/or contacted any health professional, and were also asked for any recommendations on how to improve the service. A review with a hand surgeon was organized if required, and a cost analysis was also conducted.
Overall 71/101 patients completed the telephone consultation; no patients required surgery, and the mean and median PRWE scores were 23.9/100 (SD 24.9) and 17.0/100 (interquartile range (IQR) 0 to 40), respectively. Mean patient satisfaction with treatment was 34.3/40 (SD 9.2), and 65 patients (92%) were satisfied or highly satisfied. In total there were 16 contact calls, 12 requests for a consultant review, no formal complaints, and 15 minor adjustment suggestions to improve patient experience. A relationship was found between intra-articular injuries and lower patient satisfaction scores (p = 0.025), however no relationship was found between PRWE scores and the nature of the fracture. Also, no relationship was found between the type of immobilization and the functional outcome or patient satisfaction. Cost analysis of the self-care pathway V traditional pathway showed a cost savings of over £13,500 per year with the new self-care model compared to the traditional model.
Our study supports a VFC self-care pathway for patients with minimally displaced distal radius fractures. The pathway provides a good level of patient satisfaction and function. To improve the service, we will make minor amendments to our patient information sheet.Cite this article: 2022;3(9):726-732.
我们推出了一种针对桡骨远端轻度移位骨折的自我护理方案，该方案包括患者无需经过实体复查即可从虚拟骨折诊所（VFC）出院，并获得关于如何在家自行拆除石膏或夹板的书面指导，以及锻炼和恢复功能的建议。
2020年3月至10月期间通过该方案治疗的所有患者在受伤至少六个月后由一名医疗秘书进行联系。患者被要求完成患者自评腕关节评估（PRWE）、一份满意度调查问卷，告知是否需要手术和/或联系过任何医疗专业人员，还被询问关于如何改进服务的任何建议。如有需要，安排了与手外科医生的复查，并进行了成本分析。
总体而言，71/101名患者完成了电话咨询；没有患者需要手术，PRWE评分的均值和中位数分别为23.9/100（标准差24.9）和17.0/100（四分位间距（IQR）0至40）。患者对治疗的平均满意度为34.3/40（标准差9.2），65名患者（92%）满意或非常满意。总共进行了16次联系电话，12次请求会诊复查，没有正式投诉，以及15条关于改善患者体验的小调整建议。发现关节内损伤与较低的患者满意度评分之间存在关联（p = 0.025），然而PRWE评分与骨折性质之间未发现关联。此外，固定类型与功能结果或患者满意度之间也未发现关联。自我护理方案与传统方案的成本分析表明，与传统模式相比，新的自我护理模式每年节省成本超过13500英镑。
我们的研究支持为桡骨远端轻度移位骨折患者采用VFC自我护理方案。该方案提供了较高水平的患者满意度和功能。为了改进服务，我们将对患者信息表进行小的修改。引用本文：2022；3（9）：726 - 732。
