Efficiency of a virtual fracture clinic review protocol in adult patients with distal radial fractures requiring semi-acute surgical treatment.

Abstract

Purpose: The aim of this study was to evaluate the effect of implementation of a Virtual Fracture Clinic (VFC) review protocol on the time between injury and surgery, and on secondary healthcare utilization, in patients with Distal Radius Fractures (DRFs) requiring semi-acute surgery.

Methods: Data for this retrospective before-after study were gathered between April 2017 and March 2019 (Pre-VFC n = 269), and between April 2021 and March 2023 (VFC n = 440) in a large level 2 urban trauma center. The primary outcome was the number of days between injury and operation. Furthermore secondary healthcare utilization was assessed.

Results: The average time between injury and surgery was 11.0 days (95% CI: 10.6-11.5) before and 9.2 days (95% CI: 8.9-9.6) after VFC-implementation ( p < 0.001). Following VFC-implementation, 33% (was 17%) of patients underwent surgery within 7 days, 92% (was 84%) within 2 weeks, and 99% (was 96%) within 3 weeks (p < 0.001). This included patients with delays of up to 15 days between injury and their initial hospital presentation. Hospital contacts decreased from 5 (IQR: 4-6) to 4 (IQR: 3-5) whereof physical consults decreased from 4 (IQR: 3-5) to 1 and telephone contacts increased from negligible to 1 (IQR: 1-2). Radiographs reduced from 6 (IQR: 5-7) to 4 (IQR: 3-5).

Conclusions: Implementation of a VFC-review protocol is associated with a reduced time between injury and semi-acute surgery for DRFs and reflects an improvement in quality of timely planning. Secondary healthcare utilization is reduced and a shift to remote delivery of care is observed.

Level of evidence: Level III.