The impact of digitisation of a virtual fracture clinic on referral quality, outcomes and assessment times

Background Virtual fracture clinics (VFCs) have become widely adopted, aiming to improve efficiency, standardise patient care and reduce clinic appointments for injuries that can be managed conservatively. A variety of means exist to manage VFC referrals and assessment, including paper-based and dig...

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Veröffentlicht in:European journal of trauma and emergency surgery (Munich : 2007) 2022-04, Vol.48 (2), p.1327-1334
Hauptverfasser: Sephton, Benjamin M., Morley, Hannah, Mahapatra, Piyush, Shenouda, Michael, Al-Yaseen, Mustafa, Bernstein, Darryl E., Cross, George, Dalili, Daniel E., Gurung, Amrit, Kamat, Atul, Kuc, Andrew J., Mohammed, Aisha R., Paraouty, Mehreen, Ponniah, Amsanaa, Sluckis, Ben, Deierl, Krisztian
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container_start_page 1327
container_title European journal of trauma and emergency surgery (Munich : 2007)
container_volume 48
creator Sephton, Benjamin M.
Morley, Hannah
Mahapatra, Piyush
Shenouda, Michael
Al-Yaseen, Mustafa
Bernstein, Darryl E.
Cross, George
Dalili, Daniel E.
Gurung, Amrit
Kamat, Atul
Kuc, Andrew J.
Mohammed, Aisha R.
Paraouty, Mehreen
Ponniah, Amsanaa
Sluckis, Ben
Deierl, Krisztian
description Background Virtual fracture clinics (VFCs) have become widely adopted, aiming to improve efficiency, standardise patient care and reduce clinic appointments for injuries that can be managed conservatively. A variety of means exist to manage VFC referrals and assessment, including paper-based and digital methods. This study assesses VFC referral quality and outcomes before and after implementation of a digital VFC referral and management system. Methods A retrospective analysis was conducted of all VFC referrals and assessments from July 2017–March 2020 in a large UK district general hospital. All referrals and assessments were analysed for quality and completeness of referral information, grade of assessor, outcome of assessment, referral-to-assessment time, and assessment-to-surgery time (for those requiring operative management). Results 3038 paper and 9,228 digital referrals were analysed by 2 separate reviewers. Quality and completeness of referral information showed significant improvement in 11 predetermined key data points with the digital referral system ( p  
doi_str_mv 10.1007/s00068-021-01661-9
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A variety of means exist to manage VFC referrals and assessment, including paper-based and digital methods. This study assesses VFC referral quality and outcomes before and after implementation of a digital VFC referral and management system. Methods A retrospective analysis was conducted of all VFC referrals and assessments from July 2017–March 2020 in a large UK district general hospital. All referrals and assessments were analysed for quality and completeness of referral information, grade of assessor, outcome of assessment, referral-to-assessment time, and assessment-to-surgery time (for those requiring operative management). Results 3038 paper and 9,228 digital referrals were analysed by 2 separate reviewers. Quality and completeness of referral information showed significant improvement in 11 predetermined key data points with the digital referral system ( p  &lt; 0.001). Date and mechanism of injury were the most commonly missing data criteria (67.5% and 68.2%, respectively) with paper referrals. Significant improvements were noted in the proportion of Consultant delivered VFC assessments (84.2% vs 71.0%; p  &lt; 0.001), VFC discharge rate (20.8% vs 13.1%; p  &lt; 0.001) and patients recalled for urgent review (6.2% vs 0.8%; p  &lt; 0.001) with digital referrals. Mean referral-to-assessment (31.2 vs 49.9 h; p  &lt; 0.001) and assessment-to-surgery (9.2 vs 13.0 days; p  = 0.01) times also reduced significantly with referral digitisation. Conclusion Improvements in virtual referral quality and completeness directly lead to facilitation of more thorough, detailed and appropriate virtual assessments; improving timely decision-making, reducing unnecessary appointments, and permitting better prioritisation of workload and earlier surgery for patients requiring operative treatment. Purpose-built digital solutions are an excellent means of achieving these aims.</description><identifier>ISSN: 1863-9933</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-021-01661-9</identifier><identifier>PMID: 33837452</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Ambulatory Care Facilities ; Consultants ; Critical Care Medicine ; Emergency medical care ; Emergency Medicine ; Fractures ; Fractures, Bone - surgery ; Humans ; Intensive ; Medical referrals ; Medicine ; Medicine &amp; Public Health ; Original Article ; Orthopedics ; Referral and Consultation ; Retrospective Studies ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Traumatic Surgery</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2022-04, Vol.48 (2), p.1327-1334</ispartof><rights>Crown 2021</rights><rights>2021. 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A variety of means exist to manage VFC referrals and assessment, including paper-based and digital methods. This study assesses VFC referral quality and outcomes before and after implementation of a digital VFC referral and management system. Methods A retrospective analysis was conducted of all VFC referrals and assessments from July 2017–March 2020 in a large UK district general hospital. All referrals and assessments were analysed for quality and completeness of referral information, grade of assessor, outcome of assessment, referral-to-assessment time, and assessment-to-surgery time (for those requiring operative management). Results 3038 paper and 9,228 digital referrals were analysed by 2 separate reviewers. Quality and completeness of referral information showed significant improvement in 11 predetermined key data points with the digital referral system ( p  &lt; 0.001). Date and mechanism of injury were the most commonly missing data criteria (67.5% and 68.2%, respectively) with paper referrals. Significant improvements were noted in the proportion of Consultant delivered VFC assessments (84.2% vs 71.0%; p  &lt; 0.001), VFC discharge rate (20.8% vs 13.1%; p  &lt; 0.001) and patients recalled for urgent review (6.2% vs 0.8%; p  &lt; 0.001) with digital referrals. Mean referral-to-assessment (31.2 vs 49.9 h; p  &lt; 0.001) and assessment-to-surgery (9.2 vs 13.0 days; p  = 0.01) times also reduced significantly with referral digitisation. Conclusion Improvements in virtual referral quality and completeness directly lead to facilitation of more thorough, detailed and appropriate virtual assessments; improving timely decision-making, reducing unnecessary appointments, and permitting better prioritisation of workload and earlier surgery for patients requiring operative treatment. 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A variety of means exist to manage VFC referrals and assessment, including paper-based and digital methods. This study assesses VFC referral quality and outcomes before and after implementation of a digital VFC referral and management system. Methods A retrospective analysis was conducted of all VFC referrals and assessments from July 2017–March 2020 in a large UK district general hospital. All referrals and assessments were analysed for quality and completeness of referral information, grade of assessor, outcome of assessment, referral-to-assessment time, and assessment-to-surgery time (for those requiring operative management). Results 3038 paper and 9,228 digital referrals were analysed by 2 separate reviewers. Quality and completeness of referral information showed significant improvement in 11 predetermined key data points with the digital referral system ( p  &lt; 0.001). Date and mechanism of injury were the most commonly missing data criteria (67.5% and 68.2%, respectively) with paper referrals. Significant improvements were noted in the proportion of Consultant delivered VFC assessments (84.2% vs 71.0%; p  &lt; 0.001), VFC discharge rate (20.8% vs 13.1%; p  &lt; 0.001) and patients recalled for urgent review (6.2% vs 0.8%; p  &lt; 0.001) with digital referrals. Mean referral-to-assessment (31.2 vs 49.9 h; p  &lt; 0.001) and assessment-to-surgery (9.2 vs 13.0 days; p  = 0.01) times also reduced significantly with referral digitisation. Conclusion Improvements in virtual referral quality and completeness directly lead to facilitation of more thorough, detailed and appropriate virtual assessments; improving timely decision-making, reducing unnecessary appointments, and permitting better prioritisation of workload and earlier surgery for patients requiring operative treatment. Purpose-built digital solutions are an excellent means of achieving these aims.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33837452</pmid><doi>10.1007/s00068-021-01661-9</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-8058-168X</orcidid></addata></record>
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source MEDLINE; Springer Nature - Complete Springer Journals
subjects Ambulatory Care Facilities
Consultants
Critical Care Medicine
Emergency medical care
Emergency Medicine
Fractures
Fractures, Bone - surgery
Humans
Intensive
Medical referrals
Medicine
Medicine & Public Health
Original Article
Orthopedics
Referral and Consultation
Retrospective Studies
Sports Medicine
Surgery
Surgical Orthopedics
Traumatic Surgery
title The impact of digitisation of a virtual fracture clinic on referral quality, outcomes and assessment times
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