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Fracture Apparatus Design and Protocol Optimization for Closed-stabilized Fractures in Rodents
Published on: August 14, 2018
Paediatric fracture clinic re-design: Incorporating a virtual fracture clinic
Paul M Robinson1, Francis Sim2, Mark Latimer1
1Department of Trauma and Orthopaedics, Peterborough City Hospital, North West Anglia NHS Foundation Trust, UK.
Insights
Virtual fracture clinics (VFCs) and home management safely treat paediatric fractures, reducing hospital costs. This innovative approach to paediatric orthopaedic care shows significant financial benefits and no adverse patient outcomes.
Area of Science:
- Paediatric Orthopaedics
- Healthcare Management
- Clinical Pathways
Background:
- Increasing adoption of virtual fracture clinics (VFCs) and home management protocols.
- Need to evaluate the safety and efficacy of these models in paediatric fracture care.
Purpose of the Study:
- To determine the safety and feasibility of a paediatric home management program combined with VFCs.
- To assess the impact of this integrated approach on patient outcomes and healthcare economics.
Main Methods:
- Development of home management protocols for stable paediatric fractures (ages 18 months to 15 years).
- Implementation of a VFC new patient review tariff.
- Prospective analysis of patient reviews over initial 2-month, 6-month, and 12-month periods.
Main Results:
- Significant increase in patient volume managed through VFCs over time (6.5 to 21 cases/week).
- Substantial cost savings for Clinical Commissioning Groups (£45,000/year) and hospitals (£106,000/year).
- No serious adverse events reported for patients managed via the VFC pathway.
Conclusions:
- Successful implementation of a paediatric VFC and home management program for stable fractures.
- This comprehensive reorganization of paediatric fracture services is innovative.
- Potential for significant national cost savings (estimated £10.1 million annually for NHS England).
Introduction:
The use of virtual fracture clinics (VFCs) and home management protocols is increasing. The main aim of this research is to determine whether a paediatric home management programme and VFC can be used safely to manage a range of suitable fractures in children.
Materials And Methods:
Protocols for the home management of stable paediatric fractures were designed by two consultant paediatric orthopaedic surgeons. These were for children between the ages of 18 months and 15 years 364 days. A new tariff was negotiated with the clinical commissioning groups (CCGs) for a VFC new patient review. A prospective analysis was performed for the first 2 months of the programme. Further review periods were undertaken 6 months later and 12 months after that.
Results:
Sixty-five patients were reviewed in the first 10 VFCs (mean 6.5 cases per week). After 6 months, 164 patients were reviewed in a 3-month period in the VFC, a mean of 11 cases per week. A year later the number of patients reviewed in the VFC had continued to increase with a total of 253 patients in 3 months, mean 21 cases per week. This gave a saving to the CCG of £45,000 per year and to the hospital of £106,000 per year. There were no serious adverse consequences to any patients from the use of the pathway.
Discussion And Conclusion:
We have reported on the introduction of a paediatric VFC and a home management programme for stable paediatric fractures. We are not aware of any reports in the orthopaedic literature that have described such a comprehensive and innovative re-organisation of paediatric fracture services. We estimate that the NHS could save approximately £10.1 million if all hospitals in England introduced this.
