A virtual clinic for spine fractures – a safe alternative model of care
Emily Cross1, Bernarda Cavka1, Emily Kong1, Peter Turner1, Yi Yang1, John Cunningham1, Anuruthran Ambikaipalan1, Andrew Bucknill1,21The Royal Melbourne Hospital, Melbourne, Victoria, Australia2Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
Abstract
Background: The Royal Melbourne Hospital (RMH) provides a state-wide spine trauma service in Victoria. This retrospective cohort study aimed to assess the feasibility and safety of a spine virtual fracture clinic (SVFC) as a substitute model of care for traditional outpatient visits.
Method: SVFC, established July 2022, accepted patients for orthopaedic management of low-risk acute spine fractures without neurological symptoms. An orthopaedic consultant reviewed clinical details and imaging. An Advanced Practice Physiotherapist (APP) communicated the management to the patient by telephone i.e. bracing or collars, education and advice, and repeat imaging plan. Key outcomes of the novel service: proportion of referrals diverted from the outpatient clinic; number of patients who failed management; number lost to follow up; and unplanned operations. Data were extracted from existing hospital databases.
Results: 320 referrals were received during the 7-month intervention period; 63% of patients were managed and discharged. Overall participants lived an average 106 kilometres from RMH; 62% were male. Eighteen (6%) required in-person assessment and 5(2%) were managed at another facility. Sixteen (5%) could not be contacted. Seventy-two (23%) patients were still receiving care at the end of the study period; two patients (0.6%) required operations. Five participants died of other causes (<2%). Overall, there were no adverse events using the virtual approach to clinical care. Conclusion: The SVFC was a safe, alternative model of care for patients with low-risk spine fractures. Benefits included reduced demand on hospital outpatient clinics, reduced travel burden for patients and a novel role for musculoskeletal APPs.
Biography
Emily Cross is an Advanced Practice Musculoskeletal Physiotherapist and Virtual Fracture Clinic Coordinator at the Royal Melbourne Hospital. Emily holds a Bachelor of Physiotherapy (La Trobe University, 2005) and finished top of her class in her Master of Musculoskeletal Physiotherapy (La Trobe University, 2012). Through her membership on the MPA Vic Branch committee she has been heavily involved in the organisation and delivery of professional development in Victoria since 2011. She was a clinical supervisor for the University of Melbourne’s Master of Musculoskeletal Physiotherapy program and is dedicated to facilitating professional development and education for the advancement of the profession.