• Injury · Oct 2017

    Paediatric fracture clinic re-design: Incorporating a virtual fracture clinic.

    • Paul M Robinson, Francis Sim, Mark Latimer, and Piers D Mitchell.
    • Department of Trauma and Orthopaedics, Peterborough City Hospital, North West Anglia NHS Foundation Trust, UK. Electronic address: paulrobinson79@doctors.org.uk.
    • Injury. 2017 Oct 1; 48 (10): 2101-2105.

    IntroductionThe 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 MethodsProtocols 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.ResultsSixty-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 ConclusionWe 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.Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

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