Virtual fracture clinics enable patients to receive care online

A physiotherapist and orthopaedic surgeon are transforming the way patients with fractures are treated and saving the NHS more than half a million pounds in an initiative which could become a national model.

Physio Lucy Cassidy and consultant James Gibbs have established a virtual follow-up clinic for patients with simple fractures or soft tissue injuries. In the past these patients would have come through A&E and have to return for a follow up appointment at a consultant-led fracture clinic. But today these patients receive all their post A&E care online.

The patient’s x-ray and injury is assessed within 24 hours by a physiotherapist and an orthopaedic consultant to decide if they can self-manage their recovery remotely. Patients are then phoned by the physio and offered a virtual clinic referral.

Virtual clinic patients are emailed a video message from the consultant talking through the injury and the prognosis and a link to an individual rehabilitation video – one of 27 which have been produced – with a six-week exercise plan to follow. Patients can phone a specialist physiotherapist if they have any problems; the option to come into a traditional face-to-face consultant outpatient clinic remains open.

Cassidy, an extended scope practitioner says: “This is a no brainer – it works for the patient, it works for the consultants and physios and it’s cost-efficient. Patients absolutely love the virtual clinic they say ‘What, I don’t have to come in?’ They really appreciate the service and they have a safety net.”

Some 12,000 patients have been referred to the virtual clinic run by Brighton and Sussex University hospitals NHS trust since it began three years ago. Fifty seven per cent of those patients are discharged without ever having to return to hospital; 37% have a follow up appointment at a consultant out-patient clinic and 6% are seen by a specialist physio. The service has already saved the NHS around £500,000 as the cost of a virtual referral is £67 – half the price of a traditional clinic appointment. Those savings are expected to double in the next year because since May the service has expanded to include wrist and hand injuries which account for almost half of all fracture clinic referrals.

Under the virtual system patients who require a face-to-face appointment are now booked in with the most appropriate specialist consultant at an outpatient clinic. Cassidy explains: “Under the old system it was a bit of a lottery who you saw. The patient would come to the fracture clinic and if it was run by the shoulder consultant on that day, but you had broken your ankle, you would still be seen by the shoulder consultant. One of the complaints I get from the consultants now is that ‘all my clinics are now full with people that need to be seen.’ ”

Gibbs first had the idea of a virtual fracture clinic when he was a junior doctor: “I would sit in the fracture clinic and feel exasperated for me, and for the patients, because the majority of injuries you see heal on their own with the passage of time and we were seeing people in clinic unnecessarily.”

He admits his consultant colleagues were sceptical at first about the changes but there would be a “hue and cry” now if the trust reverted to the old system: “It’s standardised treatment for specific injuries, it’s freed up consultants’ time and we are working smarter.”

The virtual clinic – which is being showcased at the NHS Health and Care Innovation Expo 2016 in Manchester next month (September) – is already being adopted by others. Virtual clinics are now run at Western Sussex hospitals NHS foundation trust and Maidstone and Tonbridge Wells NHS trust in Kent; others in Hastings and Eastbourne are due to launch in January.

A free “plug and play” package – an electronic virtual clinic blue print – is available for trusts to use as a starting point. Computer software which will allow hospitals to run their own branded virtual clinic on their own system – to be sold under license – is due to be launched next February.

Cassidy and Gibbs believe the virtual clinic – which was recognised in the NHS Innovations Challenge awards this year – could become a national model. That ambition is shared by the Chartered Society of Physiotherapists. Society professional advisor Priya Dasoju says: “We would like to see this model rolled out but it’s key that it is a physio-led service because it’s physios who can provide the rehabilitation service. It’s such a simple concept but makes such a massive difference.”

Virtual fracture clinics are new to the UK but others already exist worldwide – particularly in rural areas of Scandinavia, according to orthopaedic surgeon Stephen Cannon, vice-president of the Royal College of Surgeons.

He says: “It does require resources in terms of time from the physio and the consultant and is a huge change for patients. But it is patient-centred, it works in other parts of the world – it’s a great idea.”

Health and Care Innovation Expo in Manchester on 7 and 8 September will explore the Five Year Forward View in action. High profile health leaders will speak across two stages, while feature zones will explore digital health, personalised medicine and new models of care. NHS colleagues can attend free-of-charge. Click here to register.

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Virtual fracture clinics enable patients to receive care online

Sufferers "put at risk" by programs to enable health-related students to deal with individuals

Ideas to let new medical graduates to deal with patients will place lives at risk, health care leaders have warned.

At existing, graduates have to complete a foundation year under the supervision of an knowledgeable physician prior to they can be registered with the General Health-related Council and licensed to practise independently.

Under strategies from the health-related coaching body, Wellness Schooling England, the GMC would register graduates as they leave university following five or 6 many years, freeing them to deal with sufferers without having even more supervision. Health-related leaders will raise issues at the British Health care Association conference in Harrogate this week, saying that the ideas will place patients’ lives at chance and jeopardise graduates’ employment chances.

The program was place forward to fix a crisis in the coaching of medical doctors where there is an oversupply of health-related students graduating and a shortage of basis yr coaching areas.

Harrison Carter, the co-chairman of the BMA’s students committee, explained: “Registering straight from medical college would indicate they are medical doctors in the legal sense and could perform as locums with no further schooling or supervision.

“They would not be on a coaching path in the direction of turning into a advisor or a GP but they could nonetheless operate as a physician here or overseas in a fairly dead-finish place. This compromises patient security as there is no ongoing education or supervision.”

Katherine Murphy, of the Individuals Association, stated safety could not be jeopardised at the expense of “fast-tracking” a doctor’s education.

A spokesman for Health Schooling England explained it had been asked to carry out an options appraisal for “a extremely complex area” and was discussing it with the Department of Health.

Sufferers "put at risk" by programs to enable health-related students to deal with individuals

Enable mothers and fathers to donate the organs of infants who die, urge doctors

In the 6 years to 2012, the authorities say, 54% of the 84 infants who died in Fantastic Ormond Street have been appropriate to be organ donors. Photograph: Peter Macdiarmid/Getty Pictures

Doctors at Great Ormond Street children’s hospital are calling for the rules to be transformed to enable parents to donate the organs of newborn babies who die, in the hope of saving the lives of other sick young children.

Guidelines in the Uk do not allow infants to be certified as brain-stem dead beneath the age of two months, which is not the case in most western European nations, the US and Australia.

That implies, physicians say, that the organs of babies who have been not born prematurely but who later die in intensive care can not be transplanted to aid other babies and modest kids. They would like mother and father to be given the decision.

The Academy of Healthcare Royal Colleges’ tips, laid down in 1992, state that it is “rarely possible to confirm death using neurological criteria in infants under two months of age”, even even though it is carried out in other nations.

Donation is allowed to consider place soon after death is confirmed using “circulatory criteria”, but in that situation the heart – the organ that sick babies can only get from yet another infant simply because dimension is essential – is not usually usable.

In a paper in the journal Archives of Condition in Childhood: foetal and neonatal edition, three experts at St George’s medical school and Excellent Ormond Street make the situation for a rethink on the recommendations.

They say the predicament is “bizarre”. Organs donated by infants under two months outdated from abroad are at times transplanted into Uk infants, but the reverse never happens.

In the six many years to 2012, the experts say, just more than half (54%) of the 84 infants who died in Wonderful Ormond Street have been suitable to be organ donors. Eleven could have been donors soon after a certification of brain-stem death, even though organs from 34 others could have been used after a circulatory-death determination.

“This analysis supplies us with a glimpse of what may well be possible in the United kingdom if our recommendations around diagnosis of death in quite younger infants have been brought into line with other countries,” said Dr Joe Brierley, intensive care expert, organ donation expert and 1 of the authors of the paper.

“At Fantastic Ormond Street, we witness firsthand the urgent need for organs for young children of all ages – but little infants specifically have the odds stacked towards them simply because they need to be matched with similarly aged youngsters.

“Organ donation is a very emotive topic, notably when it requires kids, but I think it is an alternative that need to be accessible to a household if they choose it is the appropriate decision for them.

“The reduction of a little one will often be an really tragic and heartbreaking experience but a good deal of mother and father who choose to donate their child’s organs later on locate some comfort in the expertise that, at this most tragic time for their personal household, they have been able to do anything extraordinarily kind.”

Enable mothers and fathers to donate the organs of infants who die, urge doctors

New Government guidelines will enable "rubber stamping" of abortions

Almost 190,000 unwanted babies a yr are aborted in England and Wales underneath the 1967 Act which says that terminations can get area legally if two medical professionals agree in good faith that the physical or mental well being of the girl or youngster is at risk.

Ministers have admitted that less than half of girls who have abortions now see both of the medical professionals face-to-encounter just before being offered the go-ahead and new proposals contained in a Government consultation propose that it is not even a legal necessity for medical professionals to give individual requests any energetic believed prior to approving them.

“What this does, by successfully bypassing the medical professionals and leaving them as a rubber stamp overseeing the method, is erodes those protections [of the Act],” said Dr Peter Saunders, Chief Executive of the Christian Healthcare Fellowship.

“The selection about no matter whether an abortion should be carried out calls for fairly a whole lot of specialist health care understanding due to the fact you acquired to affirm on a statutory document that the danger of continuing with the pregnancy than that of possessing an abortion to the mother’s mental or physical overall health.

“I never believe that is a decision that a nurse can effortlessly make in a hectic abortion clinic that removes protection even more from the woman and most importantly the unborn child that the Act was initially meant to shield.”

New Government guidelines will enable "rubber stamping" of abortions