Impact of the COVID-19 Pandemic on the Implementation and Adoption of a Virtual Fracture Clinic Pathway: A Closed Loop Audit

Introduction: Trauma and orthopedics departments have traditionally used face-to-face (FTF) fracture clinics for non-operative fractures. Developed in 2011, the virtual fracture clinic (VFC) was fully implemented at an institution during the COVID-19 pandemic to reduce in-person interactions.

Aims: First, the study aims to measure the percentage of non-operative patients triaged through the VFC when this was optional and re-audit after implementing a COVID-19-related policy change mandating VFC triage. Second, the study aims to measure the number of FTF fracture clinic interactions and re-audit after implementing three policies: national COVID-19 lockdowns, mandated VFC triage, and early appropriate discharge.

Methods: Data from two periods were examined, pre-pandemic (2018-2020) and pandemic (2020-2022), at a university teaching hospital. We measured compliance with modified British Orthopaedic Association Standards for timely senior review, minimizing outpatient visits, and patient-initiated follow-up.

Results: The percentage of cases triaged to the VFC rose from 39% to 100%. FTF fracture clinic interactions dropped by 50.2% from 35,399 to 17,639. All three policy changes reduced FTF numbers: 3.7% due to national lockdowns, 14.7% due to VFC triage, and 35.5% due to early appropriate discharge.

Conclusions: The COVID-19 pandemic provided a window in which healthcare working partners were more receptive to change. Our institution successfully used this opportunity to implement policy changes that improved patient care and maximized resources.