Outcomes of a Novel Spine Virtual Fracture Clinic in an Australian Tertiary Hospital

Abstract

Study design. This was a retrospective cohort study. Objective. To determine the proportion of referrals diverted by the spine virtual fracture clinic (SVFC) from traditional outpatient clinic management. Summary of background data. The consistent rise in demand for orthopedic outpatient clinic services is creating marked challenges to the provision of quality care. Virtual fracture clinics for upper and lower limb fractures have reduced the burden on outpatient clinics by providing an alternative telehealth management pathway. To date, no study describes the expansion of virtual care to the spine trauma population. Methods. A study of spine fractures referred to the RMH Department of Orthopaedic Surgery was conducted comparing outcomes before (January to December 2021) and following (July 2022 to November 2023) implementation of an SVFC. The primary aim of this study was to investigate the effect of a telephone-based SVFC on outpatient clinic activity, represented by the proportion of referrals discharged without requiring an outpatient clinic appointment. Secondary aims included appointment utilization, lost to follow-up rates, duration of care, missed or misdiagnoses, unplanned operations, and complications. Results. Of the 731 referrals managed by the SVFC, 91.1% were discharged without requiring in-person outpatient clinic attendance. Compared with the outpatient clinic historical cohort (150 referrals), SVFC management was associated with reductions in the average number of consultations per referral (1.8 vs. 2.4, P<0.001), appointments not attended (5% vs. 13%, P<0.001), referrals lost to follow-up (0% vs. 10.7%, P<0.001), and a shorter duration of care (median 48 vs. 58 d, P<0.001). A total of 65 patients (8.1%) were redirected to the outpatient clinic, of which three underwent surgical intervention. No diagnostic errors, complications or adverse events were identified. Conclusion. This study demonstrates that an SVFC is an effective and safe alternative pathway to traditional hospital-based outpatient clinics, ith low-risk for any adverse outcomes.