MMUH Virtual Fracture Clinic
We recognize that not all patients with orthopaedic injuries require input from an orthopaedic surgeon or need formal assessment in the traditional fracture clinic. Many injuries can be managed safely with conservative means, with physiotherapy input or an injury specific self-directed home care programme.
Reducing attendances to the formal fracture clinic ensures that the right patient gets there in a timely fashion. It can also save patients unnecessary hospital visits and has secondary benefits eg less time off work/expensive car parking fees/shorter fracture clinics/reduced administration times.
As an alternative to the traditional fracture clinic, we have set up a virtual fracture clinic in MMUH to allow injuries to be screened in a timely fashion and potentially avoid unnecessary attendance.
The Virtual fracture clinic functions to review patients who may be suitable to self-directed treatment without attendance to a formal clinic. Certain injuries in appropriate patients are ideally suited to this approach ie radial head fractures and fifth metatarsal fractures.
To refer patients to the MMUH VFC they are discharged to the virtual fracture clinic on patient centre as a formal disposition. A brief note should be made as to the patients history, injury and the care plan that has been put in place. The patient should be provided with the necessary injury information if appropriate and information on the VFC. These documents are available on patient centre, ED documents tab. A care plan should be discussed with the patient. This should include the ED physicians care plan for the injury as they deem appropriate. Patients will be contacted following the VFC only if the care plan decision at the VFC differs from the one given to them at the time of their initial visit.
The common injury patterns suitable for conservative management include undisplaced radial head fractures, minor ankle avulsion injuries, base of 5th Metatarsal injuries.
If as the physician you are not familiar with the management of common orthopedic injuries that don’t require surgical intervention then please ask for advice in this regard.
We have set up the VFC Medxnote group to allow you to post cases where you are looking for advice regarding the management of an injury particularly if you are unsure if they may be suitable for treatment in the virtual clinic.
Messaging on the VFC Medxnote group should be communicated along the lines of an ISBAR communication tool. This should include: patients MRN, details of mechanism, injury identified, planned care plan and referrers details. X-Rays (appropriate views) should be posted. The orthopaedic service will endeavour to provide advice as soon as possible to expedite the patient through the ED.
When it is decided to refer a patient to the VFC It is imperative that important details are communicated in the text box open on the discharge page on patient centre.
At the VFC, cases referred are discussed, x-rays reviewed in conjunction with a clinical vignette and action plan by an orthopaedic senior, ANP and physiotherapist. A treatment plan will be made and the patient will be contacted only if this differs from the original plan. The VFC occurs weekly on Monday mornings (Tuesday mornings in the event of bank holidays).
Any patient whose case is reviewed at the VFC will have access to an email address (firstname.lastname@example.org) to enquire about any issues with the further care of their injury. This email address will be answered by a dedicated member of the MMUH orthopaedic service in a timely manner.
Currently referral to the VFC is directly available to ANPs, EM registrars and EM consultants. EM SHOs should discuss any cases that they feel require orthopaedic input with any of the above EM team and a treatment plan made.
Please let us know of any omissions or improvements to the service that you feel may be warranted.