Pediatric virtual fracture clinic. Our first 10K!
Flavia Alberghina1, Paula Kelly1, Jacques Noël1
1Children's Health Ireland (CHI) at Crumlin, Cooley Rd, Crumlin, Dublin, D12 N512, Ireland.
Insights
A Virtual Fracture Clinic (VFC) pathway safely and effectively manages most pediatric minor trauma, reducing the need for in-person visits and saving healthcare costs. This approach confirms treatment and allows for prompt discharge for many young patients.
Area of Science:
- Orthopedics
- Pediatric Emergency Medicine
- Health Services Research
Background:
- Traditional pediatric trauma care relies on in-person (F2F) outpatient visits.
- The study investigates the efficacy of a Virtual Fracture Clinic (VFC) pathway for managing pediatric minor trauma.
- This pathway aims for definitive management during the initial Pediatric Emergency Department (PED) visit.
Purpose of the Study:
- To evaluate the safety and effectiveness of a VFC pathway for pediatric minor trauma.
- To assess the outcomes of children managed through the VFC pathway.
- To determine the cost-effectiveness of implementing a VFC in pediatric trauma care.
Main Methods:
- Prospective data collection from patients referred to the VFC from the PED.
- Tracking outcomes including surgical referral, F2F clinic referral, PED re-referral, and discharge.
- Conducting a cost analysis based on local healthcare system data for VFC implementation.
Main Results:
- Over 4 years, 10,763 children were referred to the VFC.
- 69.8% of children were discharged directly via the VFC.
- The VFC pathway resulted in net savings of €704,667.
Conclusions:
- The VFC pathway is a safe and effective model for managing minor pediatric trauma.
- This approach significantly reduces the need for face-to-face follow-up appointments.
- Implementation of the VFC pathway leads to substantial cost savings in pediatric trauma care.
Introduction:
Pediatric trauma care has traditionally utilized a Face-to-Face (F2F) model of outpatient care. The authors hypothesized that most pediatric minor trauma care could be managed definitively on initial contact within the Pediatric Emergency Department (PED), with subsequent confirmation of treatment at an orthopedics Virtual Fracture Clinic (VFC). We describe the experience of our first 10,763 children managed via a VFC pathway in the setting of a pediatric trauma service.
Materials And Methods:
Data was prospectively collected on all patients referred to the VFC from the PED. Outcome data included referral for surgery, referral to a F2F clinic, referral back to PED for further evaluation and discharge. Cost analysis was performed using established costing for a VFC within the local healthcare system.
Results:
A total of 10,763 consecutive patients were referred to the VFC from the PED over a 4-year period. There were 6012 (56 %) males and 4751 (44 %) females. The average age was 9.4 years (0.5 -17 years). A total of 0.5 % (n= 56) were referred from the VFC for immediate operative treatment, 25.2 % (n= 2706) were referred to a F2F clinic, and 69.8 % (n= 7517) of children were discharged via the VFC. 4.5 % (n= 484) were referred back to the PED. 3.5 % (n= 383) of the discharged patients required an unplanned F2F evaluation. We calculated a net saving delivered from implementation of the VFC as €704 667.
Conclusion:
This prospective evaluation, of our first 10,763 children, has demonstrated that a VFC pathway for minor pediatric trauma is safe, effective and brings significant cost savings.
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