Elias Patrick, Cavka Bernarda, Turner Peter, Ambikaipalan Anuruthran, Cross Emily, Kong Emily, Gibb Kirsty, Yang Yi, Anderson Nathan, Yataganbaba Alper, Cunningham John
Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Parkville, VIC, Australia.
Spine (Phila Pa 1976). 2024 Sep 1;49(17):E279-E283. doi: 10.1097/BRS.0000000000005017. Epub 2024 Apr 29.
This was a retrospective cohort study.
To determine the proportion of referrals diverted by the spine virtual fracture clinic (SVFC) from traditional outpatient clinic management.
The consistent rise in demand for orthopedic outpatient clinic services is creating marked challenges to the provision of quality care. Virtual fracture clinics for upper and lower limb fractures have reduced the burden on outpatient clinics by providing an alternative telehealth management pathway. To date, no study describes the expansion of virtual care to the spine trauma population.
A study of spine fractures referred to the RMH Department of Orthopaedic Surgery was conducted comparing outcomes before (January to December 2021) and following (July 2022 to November 2023) implementation of an SVFC. The primary aim of this study was to investigate the effect of a telephone-based SVFC on outpatient clinic activity, represented by the proportion of referrals discharged without requiring an outpatient clinic appointment. Secondary aims included appointment utilization, lost to follow-up rates, duration of care, missed or misdiagnoses, unplanned operations, and complications.
Of the 731 referrals managed by the SVFC, 91.1% were discharged without requiring in-person outpatient clinic attendance. Compared with the outpatient clinic historical cohort (150 referrals), SVFC management was associated with reductions in the average number of consultations per referral (1.8 vs . 2.4, P <0.001), appointments not attended (5% vs . 13%, P <0.001), referrals lost to follow-up (0% vs . 10.7%, P <0.001), and a shorter duration of care (median 48 vs . 58 d, P <0.001). A total of 65 patients (8.1%) were redirected to the outpatient clinic, of which three underwent surgical intervention. No diagnostic errors, complications or adverse events were identified.
This study demonstrates that an SVFC is an effective and safe alternative pathway to traditional hospital-based outpatient clinics, ith low-risk for any adverse outcomes.
这是一项回顾性队列研究。
确定脊柱虚拟骨折诊所（SVFC）从传统门诊管理中转出的转诊比例。
骨科门诊服务需求的持续增长给提供优质护理带来了显著挑战。上肢和下肢骨折的虚拟骨折诊所通过提供替代的远程医疗管理途径减轻了门诊负担。迄今为止，尚无研究描述虚拟护理在脊柱创伤人群中的扩展情况。
对转诊至皇家墨尔本医院骨科的脊柱骨折患者进行研究，比较在实施SVFC之前（2021年1月至12月）和之后（2022年7月至2023年11月）的结果。本研究的主要目的是调查基于电话的SVFC对门诊活动的影响，以无需门诊预约即可出院的转诊比例来表示。次要目的包括预约利用情况、失访率、护理持续时间、漏诊或误诊、计划外手术和并发症。
在由SVFC管理的731例转诊患者中，91.1%的患者无需亲自到门诊就诊即可出院。与门诊历史队列（150例转诊）相比，SVFC管理使每次转诊的平均会诊次数减少（1.8次对2.4次，P<0.001）、未就诊预约减少（5%对13%，P<0.001）、转诊失访减少（0%对10.7%，P<0.001），护理持续时间缩短（中位数48天对58天，P<0.001）。共有65例患者（8.1%）被重新引导至门诊，其中3例接受了手术干预。未发现诊断错误、并发症或不良事件。
本研究表明，SVFC是传统医院门诊的一种有效且安全的替代途径，任何不良后果的风险较低。
