Are Virtual Fracture Clinics really "safe"? - An evaluation of the capability of a District General Hospital Virtual...

Virtual Fracture Clinics (VFCs) have been widely reported as "safe" in the literature. This is due to exceptionally low rates of missed or incorrect diagnoses and safe management of conditions. However, there has been minimal discussion about the ability of VFCs to identify safeguarding issues.

All referrals to the Unit's VFC in December 2022 were reviewed. n = 397. Each referral was reviewed to identify diagnosis, outcome, suspicion of safeguarding, type of healthcare professional referring and whether the specific safeguarding "check box" had been completed.Allied healthcare professionals (AHPs) involved in the VFC were invited to complete a questionnaire to determine their level of training and confidence in managing safeguarding issues.

Review of the VFC referrals showed most were from advanced nurse practitioners. 55 % of referrers did not engage with the specific safeguarding section on the referral. Of these 13 cases were suspicious for a safeguarding issue, of which 3 were subsequently not seen in a fracture clinic: 2 triaged to physiotherapy, 1 discharged. These could represent missed safeguarding opportunities.Review of questionnaire response showed that 86 % of respondents were up to date with mandatory safeguarding training. On average respondents felt "confident" managing safeguarding. However, the majority felt they wanted more teaching on safeguarding.

Whilst VFCs have been deemed "safe" with regards to fracture management, they may not be "safe" with regards to identification of safeguarding issues. This project demonstrates the main issues are poor quality referrals and the missed opportunity for a healthcare professional, appropriately trained in safeguarding, to assess the patient face to face.