Transforming musculoskeletal injury management using Virtual Bones: a novel digital solution

Managing musculoskeletal (MSK) injuries requires effective communication and collaboration between the emergency department (ED) and orthopaedic teams. A quality improvement project analysing virtual fracture clinic (VFC) referrals, staff challenges and the impact of the novel digital solution, Virtual Bones (VB), was undertaken at the West Suffolk Hospital. VB is a digital platform, available at the point of care, that guides clinicians in the assessment and management of MSK injury presentations in ED and referral to VFC.

VFC outcome data were collected between 2017 and 2022, with a 2-week focused data collection gathering diagnosis, ED processing times, patient leaflet distribution, VFC decisions and referral quality. An ED survey was distributed to explore staff challenges in the management of MSK injuries. Virtual Bones, a novel digital solution, was developed and deployed to enable clinicians to comprehensively digitalise MSK injury management pathways from first patient encounter to referral/discharge. Subsequent data collection cycles compared baseline to post deployment results.

The Virtual Bones pilot (undertaken May-July 2023) involved 352 users, 2400 sessions and 56 700 page views. The initial 2-week cycle included 260 patients while the subsequent cycles included a total of 258. Mean ED processing times decreased from 166 to 122 min, with an up to 90 min reduction in the Foundation Doctors' group (p<0.0001). Inappropriately referred dischargeable injuries decreased from 23 to 10. Improper documentation decreased from 58% to 30% (p<0.0001). The VFC discharge rate increased from 39% to 48% (p=0.021). Patient information leaflet use increased from 27% to 41% (p=0.032). The ED staff survey demonstrated improved staff confidence in the revealed challenges, including navigating local guidelines, locating equipment, applying immobilisation devices and supplying information leaflets.

Robust engagement with Virtual Bones, along with improved metrics, suggests that this digital solution effectively streamlined MSK injury pathways and helped staff manage challenges.