584 Developing a virtual fracture clinic and direct discharge pathway to enable remote care of paediatric patients presenting with minor injuries

• Published in: Archives of disease in childhood Vol. 108; no. Suppl 2; p. A16
• Main Authors: Mottershead, Noellie, Sen, Nandini
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2023
• Subjects: Audits; COVID-19; Education; Emergency medical care; Emergency medical services; Injuries; Pandemics; Patient satisfaction; Patients; Pediatrics; Referral; Surveys
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.26

ObjectivesOur challenge was to streamline our Virtual Fracture Clinic (VFC) which follows-up paediatric patients who have presented to our Paediatric Emergency Department (PED) with minor injuries. Our aim was to introduce a Direct Discharge pathway, facilitating discharge of specific injuries and streamlining our service, while maintaining patient care through a program of staff education and evidence-based patient information leaflets.MethodsThe first step involved auditing the existing Virtual Fracture Clinic (VFC) and performing a patient satisfaction survey. Based on these results, we then introduced a Direct Discharge pathway for specific minor injuries (see figure 1). To embed this change we undertook a staff education program, created a Paediatric Minor Injury Guide for staff and developed an array of evidence-based patient information leaflets. We the re-audited the service 6 months later to see if this had reduced referral rates.ResultsThe first audit of the Virtual Fracture Clinic (VFC) demonstrated that patients and families were happy to have the opportunity of remote follow-up consultations, reducing the need to attend hospital. We received a 9 out of 10 satisfaction rating for this service.However, we were referring large volumes of minor injuries, approximately 117 patients per month, or 4 patients a day. Some of these were identified as not requiring any follow-up. Also, telephone consultations were cumbersome to deliver for clinical staff with a high rate of non-attendance, especially for relatively minor injuries.A re-audit 6 months after implementation of the Direct Discharge pathway demonstrated 103 patients who had been discharged home instead of referred to the Virtual Fracture Clinic. This was a reduction in 18% of referrals for that month.ConclusionIntroduction of a Virtual Fracture Clinic during the Covid19 pandemic gave us the opportunity to overcome the challenges of delivering follow-up remotely to children with minor injuries. An audit and patient satisfaction survey confirmed the benefits of this remote service, including high patient satisfaction rates. However, it also revealed that some of these injuries did not require follow-up and unnecessary telephone consultations were detrimental to the service. A re-audit of the service after implementation of the Direct Discharge pathway demonstrated a reduction in referral rates to the Virtual Fracture Clinic by 18%. Introduction of a Direct Discharge pathway, alongside a staff education program and patient information leaflets have proven to be an effective way of streamlining our service, while maintaining high quality patient care.Abstract 584 Figure 1Number of direct discharges over one month from the paediatric emergency department[Figure omitted. See PDF]