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 |
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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
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doi_str_mv | 10.1007/s00068-021-01661-9 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2511243248</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2511243248</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-7452011f7f0a6b80f8913c7e2bd3b4b86add7b93f4e4fcd6c3e960ae8cf2b1553</originalsourceid><addsrcrecordid>eNp9kUlPBCEQhYnRuIz-AQ-GxIsHW1m6aTiaiVti4mU8E5oulEkvI9Am_nsZxyXx4InlffWq4CF0TMkFJaS-jIQQIQvCaEGoELRQW2ifSsELpUq6_bPnfA8dxLjMNBEV20V7nEtelxXbR8vFC2Dfr4xNeHS49c8--WiSH4f12eA3H9JkOuxCRqYA2HZ-8BZnPYCDELL2mgGf3s_xOCU79hCxGVpsYoQYexgSTj5fHqIdZ7oIR1_rDD3dXC_md8XD4-39_OqhsJyJVKznIpS62hEjGkmcVJTbGljT8qZspDBtWzeKuxJKZ1thOShBDEjrWEOris_Q2cZ3FcbXCWLSvY8Wus4MME5Rs4pSVnJWyoye_kGX4xSGPJ1molSMCqnqTLENZcMYY361XgXfm_CuKdHrJPQmCZ2T0J9JaJWLTr6sp6aH9qfk--szwDdAzNLwDOG39z-2Hy2LlLk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2649216897</pqid></control><display><type>article</type><title>The impact of digitisation of a virtual fracture clinic on referral quality, outcomes and assessment times</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><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</creator><creatorcontrib>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</creatorcontrib><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
< 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
< 0.001), VFC discharge rate (20.8% vs 13.1%;
p
< 0.001) and patients recalled for urgent review (6.2% vs 0.8%;
p
< 0.001) with digital referrals. Mean referral-to-assessment (31.2 vs 49.9 h;
p
< 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 & 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. Crown.</rights><rights>Crown 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-7452011f7f0a6b80f8913c7e2bd3b4b86add7b93f4e4fcd6c3e960ae8cf2b1553</cites><orcidid>0000-0002-8058-168X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00068-021-01661-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00068-021-01661-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33837452$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sephton, Benjamin M.</creatorcontrib><creatorcontrib>Morley, Hannah</creatorcontrib><creatorcontrib>Mahapatra, Piyush</creatorcontrib><creatorcontrib>Shenouda, Michael</creatorcontrib><creatorcontrib>Al-Yaseen, Mustafa</creatorcontrib><creatorcontrib>Bernstein, Darryl E.</creatorcontrib><creatorcontrib>Cross, George</creatorcontrib><creatorcontrib>Dalili, Daniel E.</creatorcontrib><creatorcontrib>Gurung, Amrit</creatorcontrib><creatorcontrib>Kamat, Atul</creatorcontrib><creatorcontrib>Kuc, Andrew J.</creatorcontrib><creatorcontrib>Mohammed, Aisha R.</creatorcontrib><creatorcontrib>Paraouty, Mehreen</creatorcontrib><creatorcontrib>Ponniah, Amsanaa</creatorcontrib><creatorcontrib>Sluckis, Ben</creatorcontrib><creatorcontrib>Deierl, Krisztian</creatorcontrib><title>The impact of digitisation of a virtual fracture clinic on referral quality, outcomes and assessment times</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><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
< 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
< 0.001), VFC discharge rate (20.8% vs 13.1%;
p
< 0.001) and patients recalled for urgent review (6.2% vs 0.8%;
p
< 0.001) with digital referrals. Mean referral-to-assessment (31.2 vs 49.9 h;
p
< 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><subject>Ambulatory Care Facilities</subject><subject>Consultants</subject><subject>Critical Care Medicine</subject><subject>Emergency medical care</subject><subject>Emergency Medicine</subject><subject>Fractures</subject><subject>Fractures, Bone - surgery</subject><subject>Humans</subject><subject>Intensive</subject><subject>Medical referrals</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Referral and Consultation</subject><subject>Retrospective Studies</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Traumatic Surgery</subject><issn>1863-9933</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kUlPBCEQhYnRuIz-AQ-GxIsHW1m6aTiaiVti4mU8E5oulEkvI9Am_nsZxyXx4InlffWq4CF0TMkFJaS-jIQQIQvCaEGoELRQW2ifSsELpUq6_bPnfA8dxLjMNBEV20V7nEtelxXbR8vFC2Dfr4xNeHS49c8--WiSH4f12eA3H9JkOuxCRqYA2HZ-8BZnPYCDELL2mgGf3s_xOCU79hCxGVpsYoQYexgSTj5fHqIdZ7oIR1_rDD3dXC_md8XD4-39_OqhsJyJVKznIpS62hEjGkmcVJTbGljT8qZspDBtWzeKuxJKZ1thOShBDEjrWEOris_Q2cZ3FcbXCWLSvY8Wus4MME5Rs4pSVnJWyoye_kGX4xSGPJ1molSMCqnqTLENZcMYY361XgXfm_CuKdHrJPQmCZ2T0J9JaJWLTr6sp6aH9qfk--szwDdAzNLwDOG39z-2Hy2LlLk</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Sephton, Benjamin M.</creator><creator>Morley, Hannah</creator><creator>Mahapatra, Piyush</creator><creator>Shenouda, Michael</creator><creator>Al-Yaseen, Mustafa</creator><creator>Bernstein, Darryl E.</creator><creator>Cross, George</creator><creator>Dalili, Daniel E.</creator><creator>Gurung, Amrit</creator><creator>Kamat, Atul</creator><creator>Kuc, Andrew J.</creator><creator>Mohammed, Aisha R.</creator><creator>Paraouty, Mehreen</creator><creator>Ponniah, Amsanaa</creator><creator>Sluckis, Ben</creator><creator>Deierl, Krisztian</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8058-168X</orcidid></search><sort><creationdate>20220401</creationdate><title>The impact of digitisation of a virtual fracture clinic on referral quality, outcomes and assessment times</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-7452011f7f0a6b80f8913c7e2bd3b4b86add7b93f4e4fcd6c3e960ae8cf2b1553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Ambulatory Care Facilities</topic><topic>Consultants</topic><topic>Critical Care Medicine</topic><topic>Emergency medical care</topic><topic>Emergency Medicine</topic><topic>Fractures</topic><topic>Fractures, Bone - surgery</topic><topic>Humans</topic><topic>Intensive</topic><topic>Medical referrals</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Referral and Consultation</topic><topic>Retrospective Studies</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Traumatic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sephton, Benjamin M.</creatorcontrib><creatorcontrib>Morley, Hannah</creatorcontrib><creatorcontrib>Mahapatra, Piyush</creatorcontrib><creatorcontrib>Shenouda, Michael</creatorcontrib><creatorcontrib>Al-Yaseen, Mustafa</creatorcontrib><creatorcontrib>Bernstein, Darryl E.</creatorcontrib><creatorcontrib>Cross, George</creatorcontrib><creatorcontrib>Dalili, Daniel E.</creatorcontrib><creatorcontrib>Gurung, Amrit</creatorcontrib><creatorcontrib>Kamat, Atul</creatorcontrib><creatorcontrib>Kuc, Andrew J.</creatorcontrib><creatorcontrib>Mohammed, Aisha R.</creatorcontrib><creatorcontrib>Paraouty, Mehreen</creatorcontrib><creatorcontrib>Ponniah, Amsanaa</creatorcontrib><creatorcontrib>Sluckis, Ben</creatorcontrib><creatorcontrib>Deierl, Krisztian</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sephton, Benjamin M.</au><au>Morley, Hannah</au><au>Mahapatra, Piyush</au><au>Shenouda, Michael</au><au>Al-Yaseen, Mustafa</au><au>Bernstein, Darryl E.</au><au>Cross, George</au><au>Dalili, Daniel E.</au><au>Gurung, Amrit</au><au>Kamat, Atul</au><au>Kuc, Andrew J.</au><au>Mohammed, Aisha R.</au><au>Paraouty, Mehreen</au><au>Ponniah, Amsanaa</au><au>Sluckis, Ben</au><au>Deierl, Krisztian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of digitisation of a virtual fracture clinic on referral quality, outcomes and assessment times</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>48</volume><issue>2</issue><spage>1327</spage><epage>1334</epage><pages>1327-1334</pages><issn>1863-9933</issn><eissn>1863-9941</eissn><abstract>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
< 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
< 0.001), VFC discharge rate (20.8% vs 13.1%;
p
< 0.001) and patients recalled for urgent review (6.2% vs 0.8%;
p
< 0.001) with digital referrals. Mean referral-to-assessment (31.2 vs 49.9 h;
p
< 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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issn | 1863-9933 1863-9941 |
language | eng |
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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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