Ms Kirsty Gibb1, Ms Bernarda Cavka1, A/Prof John Cunningham1, Dr Emily Kong1, Dr Anuruthran Ambikaipalan1, Dr Nathan Anderson1
1Royal Melbourne Hospital, Parkville, Australia
Biography:
Kirsty Gibb is a senior musculoskeletal physiotherapist who works in dual roles within the virtual fracture clinics and outpatient physiotherapy department at the Royal Melbourne Hospital. She has a passion for process improvement, student education and monitoring patient outcomes.
Abstract:
Aim:
To evaluate the efficacy and safety of an international first spine virtual fracture Clinic (SVFC) pioneered at The Royal Melbourne Hospital.
Methods:
The SVFC was conducted at our institution weekly by an orthopaedic surgeon and senior musculoskeletal physiotherapist. The study compared outcomes prior to (January to December 2021) and following (July 2022 to November 2023) SVFC implementation. The primary aim was to investigate the effects of this telephone-based service on outpatient clinic activity, represented by the proportion of referrals discharged without requiring clinic attendance. Secondary aims included comparing SVFC outcomes with traditional outpatient clinics (appointment utilisation, loss to follow-up rates, and duration of care) and the safety of the service (missed/misdiagnoses, unplanned operations, and complications).
Results:
A total of 91.9% (n=666) of referrals managed by the SVFC were discharged without in-person clinic attendance. Compared to outpatient clinic management (n=150 referrals), SVFC implementation was associated with reductions in the average number of consultations per referral (1.8 versus 2.4, p<0.001), appointments not attended (5% versus 13%, p<0.001), referrals lost to follow-up (0 versus 10.7%, p<0.001) and a shorter duration of care (median 48 days versus 58 days, p<0.001). A total of 65 patients (8.1%) were redirected to in-person clinics, three of whom underwent surgical intervention, demonstrating that the SVFC does not substitute for in-person care when required. No diagnostic errors, complications or adverse events were identified.
Conclusion:
This study demonstrates that an SVFC is an effective and safe alternative management pathway for stable spine fractures with low risk of adverse outcomes.