Paediatric Virtual Fracture Clinic at the Alex
The Paediatric Virtual Fracture Clinic (PVFC) is a service run by the paediatric orthopaedic (bone) doctors and physiotherapist team.
Introduced to the Royal Alexandra Children’s Hospital (the Alex) in Brighton in August 2019, the initiative has been developed thanks to funding from Rockinghorse. The Paediatric Virtual Fracture Clinic has been created in addition to the standard fracture clinic. The service enables the team to review a child’s injury without the necessity of attending clinic.
As a child’s parent, carer or relative, the new service is resulting in fewer or no visits to clinic at all. This means that time doesn’t need to be booked off from work or school. Many bone injuries in children tend to heal well without the need for frequent visits to hospital and the new Paediatric Virtual Fracture Clinic addresses that.
The service has been set up to provide an alternative solution to families who are required to travel to a standard fracture clinic. The new model means that X-rays are reviewed by a consultant orthopaedic surgeon and an individual plan is made for each child.
Senior physios liaise with patients and their parents directly, supported by online information and videos. This enables both parties to have a visual understanding of what’s happening.
Developing the Paediatric Virtual Fracture Clinic
We sat down with Dr Tom Crompton, Children’s Orthopaedic Consultant at the Alex, who was joined by Alison Peacock, Senior Paediatric Physiotherapist, to find out more about the Paediatric Virtual Fracture Clinic…
Dr Tom Crompton begins by explaining why it has been created. He says, “We noticed that in the traditional fracture clinic, at least half of the children who attended didn’t need to be there. It could be that some of the injuries were very trivial and could have been managed with some further information at home.
“With more detailed research, we found that families were travelling about 10 miles on average, just to attend clinic. Of those families, over 90% travelled by car and then needed to find somewhere to park, as well as paying for the parking.
“We spoke with parents to find out what could be done. When we asked if parents would be happy not to attend clinic with their child if it was safe to do so, the invariable answer was ‘yes’. From this research, the Paediatric Virtual Fracture Clinic was developed.”
Dr Crompton, continues, “We’ve recorded information videos for parents in partnership with NHS England, which are hosted on YouTube. In addition, we’ve also produced PDF leaflets, so that parents can access the information however they want.
“We estimate that around 1,500 young patients a year should benefit from the service. In the first few months since the clinic was launched, we’ve been able to treat over 50% of cases outside of the clinic. The feedback we’ve received so far has been really positive.”
How the service is making a difference
Alison Peacock deals directly with patients and explains how the Paediatric Virtual Fracture Clinic has been making a difference. She says, “We’ve found that many parents are relieved not to have to come into clinic. Many are grateful that they don’t need to cancel planned holidays or take time off work as per the traditional clinic system.
“Of course, we want parents to feel reassured, so there is always the option to come in and see us if they’d like to. We are available to parents over the phone or email if they’re concerned.
“If we feel that a patient isn’t completely better, then we can also make sure that they don’t need to go back into the referral system. This can generate further stress and anxiety for all concerned.
“We’re also preventing unnecessary referrals to physio by assessing patients on a case by case basis. The traditional system means that all injuries are automatically referred to physio, whereas we can speak with parents to find out how their child is getting on. In many cases, we have found that ongoing physio support isn’t always necessary.
“Of course, we’re not making presumptions that a child is okay. In fact, the family are getting contact from the hospital much sooner. For example, if they’ve been referred from the Children’s Emergency Department (CED) to physio, they wouldn’t have been seen for at least two weeks. Whereas with our new system, we will call them within four to seven days.
“Looking at the statistics from the first few weeks of the clinic, it shows that between 30 August 2019 to 20 September 2019, we received 155 referrals with only 42% of those patients needing to come into clinic. The rest of the cases were dealt with remotely.”
Alleviating anxiety and concern
It seems that the Paediatric Virtual Fracture Clinic is already having a hugely positive outcome for patients and parents alike. Zoe Rothery is mum to a patient who has used the service and explains how it’s helped her.
She says, “It was great to receive personal reassurance and advice about my son’s injury. The fact that we didn’t have to take additional time going back to hospital for an appointment when it wasn’t needed, was really helpful. It was handy to have the back up of an email contact that I could use if I did have any other concerns too.”
Dr Crompton, explains more, “One of the biggest issues we have here is anxiety. I remember going into hospital as a child and it being a stressful experience. This is exactly why we set up the Paediatric Virtual Fracture Clinic – if you can avoid children coming into hospital, it’s a better option all round.
“We worked out that on average, children can miss up to seven days of school by attending hospital appointments – some of which aren’t necessary. If we can keep children in school rather than having days off, it is a much preferable solution.
“The same goes for families too. Because some parents may not be working whilst they’re bringing up young children, the time they have to take off from work is slightly lower. However, we found that on average, a parent has to take three days off of work to fulfil their child’s hospital appointments.”
Improving non-attendance rates
Dr Crompton, continues, “The above doesn’t even cover other costs included as part of this. We worked out that teamed with travel, parking and time off work, each appointment costs parents around £40. Before we started the clinic, there was a 10-15% ‘did not attend’ rate. It’s not because they didn’t want to come, but it’s often because they couldn’t afford to, weren’t able to travel to see us, or couldn’t take the time off work.
“Our ‘did not attend’ rate has gone down significantly since the introduction of the Paediatric Virtual Fracture Clinic thanks to funding from Rockinghorse – it’s had a huge impact so far. Of course, there’s still room to improve it following the initial set up and pilot period. We’re coming to the end of that process now and we want to ensure that it’s an ongoing service offered at the Alex.”
Rockinghorse is the official fundraising arm of the Royal Alexandra Children’s Hospital in Brighton. We raise funds for life-saving and cutting-edge equipment, additional services and items to ensure that children are treated in an environment better suited to their needs.
Update on the success of the virtual clinic
At the current time the COVID crisis has meant it’s not as safe to visit hospital as it would normally but this is exactly where the clinic really comes into its own. Dr. Crompton explains why; “The Paediatric Virtual Fracture Clinic has had a dramatic effect on our ability to provide a safe and effective trauma service to the children of Brighton and Sussex. Other clinics and hospitals have contacted me about setting up similar services during the COVID crisis as they work so well.
“All our local children with fractures are screened by a children’s consultant so no child or family has to travel to the hospital unnecessarily during this time. Had we not had the clinic set up before COVID twice the number of patients and families would still be travelling to The Alex for their fracture advice. The increase in risk of transmission of the virus with busier clinics making it more difficult to properly social distance would have been very difficult to manage.
“We are indebted to Rockinghorse for getting the Virtual Fracture Clinic off the ground!”