scholarly journals Quality and Evaluation Report: Virtual Fracture Clinic at Wythenshawe Hospital

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Christian Warner ◽  
Anand Pillai
Keyword(s):  
Discharge Rate ◽  
Royal Infirmary ◽  
Fracture Clinic ◽  
Face To Face ◽  
Discharge Rates ◽  
Level Of Satisfaction ◽  
Rate Versus ◽  
Number Of Patients ◽  
Virtual Fracture Clinic

 Background: Following its introduction at Glasgow Royal Infirmary in 2011, the Virtual Fracture Clinic model of managing outpatient musculoskeletal injuries has grown significantly in popularity. Wythenshawe Hospital introduced this model to their orthopaedic department in 2015. Aims: How do individual consultants vary in terms of discharge rate versus face-to-face follow up when reviewing cases in a Virtual Fracture Clinic? To assess patients’ level of satisfaction with the management of their injury under a Virtual Fracture Clinic System. Methods: A retrospective study of a cohort of patients over 12 months from 11th May 2017 to 11th May 2018. Data regarding the number of patients reviewed in Virtual Fracture Clinic during this time was collected and the numbers of patients discharged or recalled for follow up analysed. A telephone questionnaire based on the NHS Friends and Family Test was collected from 50 patients within this cohort to assess overall satisfaction with their care. Results: 3361 patients were referred to virtual fracture clinic during the inclusion period. The mean percentage of cases discharged from virtual fracture clinic is 30.4% with a median of 30.5%. The rates of discharge ranged from Consultant G at 13% to Consultant K at 39%. 88% of patients would recommend this service to their friends and family and 80% would rate the service at the level of good or excellent. Conclusion: A virtual fracture clinic model has been successfully implemented at Wythenshawe saving approximately 1157 appointments in 12 months. There is significant variation in discharge rates between consultants which appears to be influenced by the number of patients seen. Individual factors which affect this require further investigation. Patients are very satisfied with their care through the Virtual Fracture Clinic at Wythenshawe Hospital and an overwhelming majority would recommend this to others.

scholarly journals 688 Rapid Implementation of Virtual Fracture Clinic During COVID 19 Reduces Both Face-To-Face Appointments and Facilitates Rapid Feedback and Education to Be Delivered to The Emergency Department

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Havenhand ◽  
L Hoggett ◽  
A Bhutta
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Prospective Data ◽  
Fracture Clinic ◽  
Face To Face ◽  
Return Rates ◽  
Acute Hospitals ◽  
Virtual Fracture Clinic ◽  
Improve Patient

Abstract Introduction COVID-19 has dictated a shift towards virtual clinics. Pennine Acute Hospitals NHS Trust serves over a million patients with a significant number of face-to-face fracture clinics. Introduction of a Virtual Fracture Clinic (VFC) reduces hospital return rates and improves patient experience. The referral data can be used to give immediate monthly feedback to the referring department to further improving patient flow. Method Prospective data was collected for all referrals to VFC during March 2020. Data included referral diagnosis, actual diagnosis, referrers grade, and final outcome. Results 630 referrals were made to VFC. 347 (55%) of those referrals were directly discharged without the need for physical consultation. Of these 114 (32%) were injuries which can be discharged by the Emergency Department with an advice leaflet using existing pathways. Of the remaining discharges 102 (29%) were query fractures or sprains; and 135 (39%) were minor fractures; which needed only advice via a letter and no face to face follow up. Conclusions Implementation of VFC leads to a decrease in physical appointments by 55% saving 347 face to face appointments. The new system has also facilitated effective audit of referrals in order to further improve patient flow from the Emergency Department via feedback mechanisms and education.

341 Alder Hey Experience of Paediatric Virtual Fracture Clinic During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Stead ◽  
M Ashraf ◽  
S Gandham ◽  
M Khattak ◽  
C Talbot
Keyword(s):  
Patient Contact ◽  
Fracture Clinic ◽  
Social Challenges ◽  
Face To Face ◽  
Elbow Injuries ◽  
Rapid Transition ◽  
Clavicle Fractures ◽  
Alder Hey ◽  
Virtual Fracture Clinic

Abstract Introduction The SARS-CoV2/COVID-19 pandemic represented an unprecedented emergency prompting a drive to minimise non-essential patient contact and the need for a virtual fracture clinic (VFC); an uncommon practice in paediatric units. Management of paediatric fractures requires a greater degree of vigilance to safeguard children. The current climate has created social challenges that theoretically increase the risk of harm and exploitation to children. This study investigates VFC in the management of paediatric fractures to determine the efficiency of such a process and the risk of safeguarding. Method A protocol was devised in affiliation with BSCOS for the immediate management and streamlining of paediatric fractures into VFC. We retrospectively audited 235 VFC consults over a 1-month period. Patient sex was roughly evenly distributed, and age ranged from 9 months to 16 years (mean 8.4 years). Results 42% of patients were recalled for a face-to-face (F2F) review (26% expedited), primarily for clinical assessment, plaster complaints and imaging requirements. 33% were discharged and 15% continued follow-up in VFC. All clavicle fractures were discharged. Forearm, hand, foot and elbow injuries were more likely to be discharged. Lower leg, upper arm and knee presentations more frequently required a F2F review. 2.3% of cases required safeguarding reviews. Conclusions Given the rapid transition to VFC without the use of triage we have determined a number of non-complex fractures safely managed and discharged via VFC. The low percentage of recall due to safeguarding concern highlights this may not be a barrier to the continuation of virtual care outside of the context of a pandemic.

scholarly journals Optimizing orthopedic trauma care delivery during the COVID-19 pandemic. A closed-loop audit of implementing a virtual fracture clinic and fast-track pathway in a Dutch level 2 trauma center

2021 ◽  
Vol 6 (1) ◽  
pp. e000691
Author(s):  
Thijs H Geerdink ◽  
Dorien A Salentijn ◽  
Kristin A de Vries ◽  
Philou C W Noordman ◽  
Johanna M van Dongen ◽  
...  
Keyword(s):  
Waiting Time ◽  
Fast Track ◽  
Closed Loop ◽  
Treatment Plan ◽  
Trauma Patients ◽  
Orthopedic Trauma ◽  
Fracture Clinic ◽  
Face To Face ◽  
Virtual Fracture Clinic

BackgroundGuidelines concerning outpatient management of patients during the coronavirus pandemic required minimized face-to-face follow-up and increased remote care. In response, we established a virtual fracture clinic (VFC) review for emergency department (ED) patients with musculoskeletal injuries, meaning patients are reviewed ‘virtually’ the next workday by a multidisciplinary team, instead of routine referral for face-to-face fracture clinic review. Patients wait at home and are contacted afterwards to discuss treatment. Based on VFC review, patients with minor injuries are discharged, while for other patients an extensive treatment plan is documented using injury-specific care pathways. Additionally, we established an ED orthopedic trauma fast-track to reduce waiting time. This study aimed to evaluate the extent to which our workflow supported adherence to national coronavirus-related guidelines and effects on ED waiting time.MethodsA closed-loop audit was performed during two 4-week periods using predefined standards: (1) all eligible ED orthopedic trauma patients are referred for VFC review; (2) reached afterwards; and follow-up is (3) patient initiated, or (4) performed remotely, whenever possible. Total ED waiting time, time to review, time for review, and time after review were assessed during both audit periods and compared with previous measurements.ResultsDuring both audits, the majority of eligible ED patients were referred for VFC review (1st: n=162 (88.0%); 2nd: n=302 (98.4%)), and reached afterwards (1st: 98.1%; 2nd: 99.0%). Of all referred patients, 17.9% and 13.6% were discharged ‘virtually’ during first and second audits, respectively, while 45.0% and 41.1% of scheduled follow-up appointments were remote. Median total ED waiting time was reduced (1st: −36 minutes (p<0.001); 2nd: −33 minutes (p<0.001)). During the second audit, median ED time to review was reduced by −13 minutes (p<0.001), as well as time for review: −10 minutes (p=0.019).DiscussionIn line with national guidelines, our VFC review allowed time-effective review and triage of the majority of ED orthopedic trauma patients, supporting patient-initiated and remote follow-up, whenever possible. ED waiting time was reduced after implementing the VFC review and orthopedic trauma fast-track.Level of evidenceIV.

scholarly journals Telephone versus face-to-face neuro-oncology consultations: comparing patient satisfaction, convenience, family support and clinician attitude during the COVID-19 pandemic

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv14-iv14
Author(s):  
Emma Toman ◽  
Claire Goddard ◽  
William Garratt ◽  
Frederick Berki ◽  
Zenab Sher ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Family Member ◽  
Telephone Consultation ◽  
Face To Face ◽  
Oncology Service ◽  
Level Of Satisfaction ◽  
Number Of Patients ◽  
Significant Difference ◽  
Remote Consultations

Abstract Aims During the first wave of the COVID-19 pandemic, to limit the number of patients attending hospital, the neuro-oncology department selected a large number of appointments to be conducted via the telephone. This project aimed to determine how patients and clinicians perceived telephone consultations in the neuro-oncology service compared to traditional face to face appointments. Method A 20-question patient satisfaction survey combined quantitative and qualitative questions and was distributed between June and August 2020. These were distributed by email to 88 patients who attended neuro-oncology clinic in person ("face-to-face"), or by telephone. Concurrently, a 15-question survey was distributed to all clinicians conducting telephone and face-to-face consultations for the neuro-oncology service. Questions included in the clinician survey were designed to mirror the patient satisfaction questionnaire where possible. Fisher's exact test was used to determine significance, which was set at p&lt; 0.05. Results 51.1% (n=45) of patients returned the questionnaire. Of those who received telephone appointments, 89.5% (n=17) felt the consultation was convenient, 94.7% (n=18) were satisfied and 80.0% (n=16) were able to have a family member/friend present. Of those who attended face-to-face appointments, 96.0% (n=24) felt their consultation was convenient, 100% (n=25) were satisfied and 87.5% (n=21) were able to have a family member/friend present. There was no significant difference in patient convenience, satisfaction or family/friend presence (p=0.395, p=0.432 and p=0.498 respectively) between face-to-face and telephone clinics. Overall, the clinicians reported undertaking a mean of 9.5 telephone consultations per week. Only 42.8% (n=3) use telephone appointments for first-time neuro-oncology consultations, whereas 100.0% (n=7) use them for results and follow-up appointments. Only 51.7% (n=4) felt that undertaking telephone consultations is convenient and 42.8% (n=3) have experienced difficult situations with patients during telephone consultation. Conclusion This project suggests that neuro-oncology telephone consultations provide patients with the same level of satisfaction and convenience as face-to-face appointments. We have also demonstrated that using the telephone does not provide a significant barrier to having family or friends present to support the patient. We have shown that clinicians are universally utilising neuro-oncology telephone appointments for follow-up and results whereas much fewer use the telephone for performing initial consultations. Given the high-level of satisfaction demonstrated in the patient questionnaires this reflects effective patient-selection for remote consultations. The COVID-19 pandemic has forced oncology services to evolve and results of this project suggest that telephone neuro-oncology consultations are widely accepted by patients and clinicians. We therefore propose that remote consultations should continue beyond the pandemic in select cases.

The ENT emergency clinic: does senior input matter?

2012 ◽  
Vol 127 (1) ◽  
pp. 15-19 ◽  
Author(s):  
A Mirza ◽  
L McClelland ◽  
M Daniel ◽  
N Jones
Keyword(s):  
Quality Of Care ◽  
Discharge Rate ◽  
Surrogate Marker ◽  
Operating Theatre ◽  
Number Of Children ◽  
Discharge Rates ◽  
Time Period ◽  
Number Of Patients

AbstractBackground:Many ENT conditions can be treated in the emergency clinic on an ambulatory basis. Our clinic traditionally had been run by foundation year two and specialty trainee doctors (period one). However, with perceived increasing inexperience, a dedicated registrar was assigned to support the clinic (period two). This study compared admission and discharge rates for periods one and two to assess if greater registrar input affected discharge rate; an increase in discharge rate was used as a surrogate marker of efficiency.Method:Data was collected prospectively for patients seen in the ENT emergency clinic between 1 August 2009 and 31 July 2011. Time period one included data from patients seen between 1 August 2009 and 31 July 2010, and time period two included data collected between 1 August 2010 and 31 July 2011.Results:The introduction of greater registrar support increased the number of patients that were discharged, and led to a reduction in the number of children requiring the operating theatre.Conclusion:The findings, which were determined using clinic outcomes as markers of the quality of care, highlighted the benefits of increasing senior input within the ENT emergency clinic.

scholarly journals Are telephone consultations here to stay in rheumatology?

2020 ◽  
Author(s):  
Sabrina R Raizada ◽  
Natasha Cleaton ◽  
James Bateman ◽  
Diarmuid M Mulherin ◽  
Nick Barkham
Keyword(s):  
Older Patients ◽  
Online Survey ◽  
Vulnerable Groups ◽  
Age Group ◽  
Telephone Consultation ◽  
Survey Tool ◽  
Face To Face ◽  
Vulnerable Patients ◽  
Number Of Patients

Abstract Objectives During the COVID-19 pandemic, face-to-face rheumatology follow-up appointments were mostly replaced with telephone or virtual consultations in order to protect vulnerable patients. We aimed to investigate the perspectives of rheumatology patients on the use of telephone consultations compared with the traditional face-to-face consultation. Methods We carried out a retrospective survey of all rheumatology follow-up patients at the Royal Wolverhampton Trust who had received a telephone consultation from a rheumatology consultant during a 4-week period via an online survey tool. Results Surveys were distributed to 1213 patients, of whom 336 (27.7%) responded, and 306 (91.1%) patients completed all components of the survey. Overall, an equal number of patients would prefer telephone clinics or face-to-face consultations for their next routine appointment. When divided by age group, the majority who preferred the telephone clinics were &lt;50 years old [χ2 (d.f. = 3) = 10.075, P = 0.018]. Prevalence of a smartphone was higher among younger patients (&lt;50 years old: 46 of 47, 97.9%) than among older patients (≥50 years old: 209 of 259, 80.7%) [χ2 (d.f. = 3) = 20.919, P &lt; 0.001]. More patients reported that they would prefer a telephone call for urgent advice (168, 54.9%). Conclusion Most patients interviewed were happy with their routine face-to-face appointment being switched to a telephone consultation. Of those interviewed, patients &gt;50 years old were less likely than their younger counterparts to want telephone consultations in place of face-to-face appointments. Most patients in our study would prefer a telephone consultation for urgent advice. We must ensure that older patients and those in vulnerable groups who value in-person contact are not excluded. Telephone clinics in some form are here to stay in rheumatology for the foreseeable future.

scholarly journals Establishing a nurse-led thyroid cancer follow-up clinic

2021 ◽  
Vol 30 (4) ◽  
pp. S28-S35
Author(s):  
Andrew Fishburn ◽  
Nicola Fishburn
Keyword(s):  
Thyroid Cancer ◽  
Complex Disease ◽  
Disease Recurrence ◽  
Patient Survey ◽  
Safe Patient Care ◽  
Face To Face ◽  
Number Of Patients ◽  
Risk Of Disease

Thyroid cancer is a complex disease requiring management by a large multidisciplinary team. The number of patients with a diagnosis of thyroid cancer is significantly increasing year-on-year, and traditional models of consultant-led follow up are no longer sustainable. Although nurse-led cancer follow-up clinics are becomining increasingly common, thyroid cancer nurse-led follow-up clinics are rare. An excellent understanding of the disease, treatment and management of risk of disease recurrence is essential for safe patient care, and is discussed in this article. The clinic discussed uses the skill set of head and neck nurse specialists, including psychological support, coping strategies for long-term side effects of treatment and non-medical prescribing. A patient survey of the service revealed high levels of patient satisfaction and a desire to continue face-to-face consultations rather than telephone clinics.

scholarly journals Education in Neurology Resident Documentation Using Payroll Simulation

2017 ◽  
Vol 9 (2) ◽  
pp. 231-236 ◽  
Author(s):  
John W. Liang ◽  
Vicki L. Shanker
Keyword(s):  
Medical Decision ◽  
Financial Loss ◽  
Income Loss ◽  
Face To Face ◽  
Number Of Patients ◽  
Specific Feedback ◽  
Didactic Lecture ◽  
E Mail

ABSTRACT Background Approaches for teaching neurology documentation include didactic lectures, workshops, and face-to-face meetings. Few studies have assessed their effectiveness. Objective To improve the quality of neurology resident documentation through payroll simulation. Methods A documentation checklist was created based on Medicaid and Medicare evaluation and management (E/M) guidelines. In the preintervention phase, neurology follow-up clinic charts were reviewed over a 16-week period by evaluators blinded to the notes' authors. Current E/M level, ideal E/M level, and financial loss were calculated by the evaluators. Ideal E/M level was defined as the highest billable level based on the documented problems, alongside a supporting history and examination. We implemented an educational intervention that consisted of a 1-hour didactic lecture, followed by e-mail feedback “paystubs” every 2 weeks detailing the number of patients seen, income generated, income loss, and areas for improvement. Follow-up charts were assessed in a similar fashion over a 16-week postintervention period. Results Ten of 11 residents (91%) participated. Of 214 charts that were reviewed preintervention, 114 (53%) had insufficient documentation to support the ideal E/M level, leading to a financial loss of 24% ($5,800). Inadequate documentation was seen in all 3 components: history (47%), examination (27%), and medical decision making (37%). Underdocumentation did not differ across residency years. Postintervention, underdocumentation was reduced to 14% of 273 visits (P &lt; .001), with a reduction in the financial loss to 6% ($1,880). Conclusions Improved documentation and increased potential reimbursement was attained following a didactic lecture and a 16-week period in which individual, specific feedback to neurology residents was provided.

scholarly journals Does it Matter Whom You See?–A Fracture Clinic Audit

2006 ◽  
Vol 88 (6) ◽  
pp. 540-542 ◽  
Author(s):  
TDA Cosker ◽  
A Ghandour ◽  
T Naresh ◽  
K Visvakumar ◽  
SR Johnson
Keyword(s):  
Complex Trauma ◽  
Discharge Rate ◽  
Trauma System ◽  
Presentation Rate ◽  
Fracture Clinic ◽  
Complete Cycle ◽  
Junior Staff ◽  
Number Of Patients ◽  
The Uk

INTRODUCTION A consultant-led service for trauma in the UK has become the accepted norm. Practice in fracture clinics may vary widely between consultants and has an impact on the number of patients seen and, therefore, the time devoted to each patient. PATIENTS AND METHODS A total of 945 patients attending our unit's fracture clinics were analysed over a 6-week period, representing one complete cycle of our trauma system. RESULTS The overall discharge rate was 38% but this differed significantly between consultants. Patients re-presenting for the same complaint were evenly distributed between those discharging aggressively and those re-reviewing regularly. CONCLUSIONS Re-reviewing patients has a significant impact on the number of patients seen in future clinics and, therefore, the time that can be devoted to each patient, individual consultant workload and teaching of junior staff. Since the re-presentation rate between those discharging aggressively and those re-reviewing more frequently was the same, discharge protocols are recommended for common trauma conditions to standardise the process. Specialist clinics are recommended for more complex trauma cases.

Surgical ICU Underutilization Does not Significantly Discourage Discharge

1996 ◽  
Vol 9 (4) ◽  
pp. 238-242 ◽  
Author(s):  
F. Dexter ◽  
K. Pearson ◽  
D. L. Griffiths ◽  
P. Jebson
Keyword(s):  
Discharge Rate ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Patient Discharge ◽  
Poor Quality ◽  
Excess Capacity ◽  
Admission Rates ◽  
Discharge Rates ◽  
Number Of Patients

An SICU must have sufficient capacity to handle peak weekly demand to prevent re-admission and/or poor quality of care. Excess capacity may, however, encourage unnecessary SICU utilization. The goal of this study was to assess the influence of availability of SICU beds on patient discharge and re-admission rates. The case series included 1,492 days, 36,816 patient days, 8,821 discharges, and 186 re-admissions within 3 days from a 24-bed multidisciplinary SICU at a tertiary care center. Census was defined to equal the total number of patients in the SICU each day. We found low census levels were not associated with significantly lower discharge rates. Decreasing the census from 19–24 to 13–18 patients per day decreased discharge rates from 31% to 30%. Odds ratio that a decrease in census by five from 24 decreased discharge rate equaled 1.01 (95% confidence interval 0.96 to 1.06). We conclude that when hospital managers choose an appropriate SICU capacity they need not be concerned that intermittent excess capacity will prompt physicians to significantly decrease their discharge rates.

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