Understanding Virtual Fracture Clinic's

James Gibbs Orthopaedic Consultant BSUH NHS TrustLucy Cassidy Advanced Practice Physiotherapist BSUH NHS TrustSophie Richardson Technical Sales Manager Microsoft

Think of a time before the internet and Wifi… so pre 1991

Online shopping – Smart, interactive, constantly evolving to serve the customer betterBuying car insurance – comparison sites, able to compare and contrast multiple streams of informationThe train line -

Examples of digital solutions making life easier…

Private service providers

What do they all have in Common?

Lets play spot the difference in the NHS….

Despite vast leaps and bounds in the development of technology the NHS is still very slow to harness the efficiencies of just the simplest technologies.

You get a letter for your appointment that if you need to change to make a phone call…

1. Health and wellbeing gap – Prevention 2. The care and quality gap – ‘Unless we

Reshape care deliveryHarness technologyDrive down variations in quality and safety of care then patients’ changing needs will go unmet, people will be harmed who should have been cured, and unacceptable variations in outcomes will persist.’

3. The funding and efficiency gap

NHS 5 year forward

Location: Brighton, EnglandDate: April 2nd 2013

80+ steps or 3 lifts

Why Change?

Waits of up to 90 minutes for hospital car parking space

The question we considered was….

Is the current, widely used model for the new-patient fracture clinic the most patient-focused, cost effective, and evidence-based model that can be used at BSUH & Nationally?

Evaluation of traditional practice

45% of patients required time off work to attend the clinic. 44% of patients were discharged on their first appointment.We scored highly on:

– Patients feeling that they were listened to (89%)– Results were explained (84%) – Patients given an opportunity to ask questions (87%)

But only 44% were given any advice on exercises or what to do next. Overall patient satisfaction was 76%.

Key: National, Organisational and Individual factors

Drivers for challenging existing practice

National level:• NHS deficit • Right Information, Right Place, Right Time • Reduced sickness

Organizational level:• Waiting times for T&O follow-

up • Waiting time for OP

physiotherapy Wrong profession, wrong place, wrong time

Individual level:• Inconsistent level of care

spectrum from fellow to consultants

• Variation of treatment management

• Over-imaging of patients?• Unnecessary time off

work to attend clinics with no change of management plan

1. Improve patient experience by bringing first-line treatment to them in the comfort of their own home.

2. Ensuring that all management decisions are made by an Orthopaedic Consultant and that any follow-up care is under the correct specialist in the correct time frame.

3. That all patients receive standardised, protocol-driven, evidence-based treatment to ensure a high standard of care for all patients, which is shared with their GP.

4. Reduce the number of outpatient appointments with a knock-on effect to supporting services such as physio, imaging & admin.

Objectives set for the VFC

“Right Professional, Right Place, Right Time”

Location: Brighton, EnglandDate: 27th August 2013