Virtual fracture clinics at the Royal Free London will allow many patients to manage their broken bones safely and effectively at home while cutting clinic waiting times for those that do have to return to hospital.

Traditionally patients suffering suspected fractures attend A&E for an x-ray and initial treatment and then, assuming there is a break, return to the fracture clinic the following day for assessment by a doctor or physiotherapist, who will decide if they need specialist treatment or can be discharged.

There is a lot of demand on the fracture clinic service and  patients can often face lengthy waits before they are seen by a clinician, who may only need to give advice on how the patient can care for the fracture themselves at home.

The new virtual fracture clinic means patients with certain conditions can be sent home from A&E after their x-ray and initial treatment with information leaflets and advice from specially-trained A&E staff. They then receive a telephone call from a member of the orthopaedic team who has reviewed their scans and will discuss with them whether they need to come in for further treatment by a specialist consultant or physiotherapist, or if they can manage the injury at home. Patients who are recommended for treatment at home are still free to come in for an appointment if they choose and can call a dedicated helpline for patients to call if they have any queries or concerns.

The programme was first piloted by Glasgow Royal Infirmary, which saw a significant reduction in footfall to the fracture clinic while maintaining recovery times. The programme has since been adopted by several NHS trusts throughout the country.

Derek Park, consultant orthopaedic surgeon at Barnet Hospital and clinical lead for the virtual fracture clinic project, said: “The virtual fracture clinic is a safe and effective way of improving patients’ experience while reducing demand on vital hospital services.

“Considering the pain and mobility problems fracture clinic patients are likely to be experiencing, it is obviously a huge benefit if they are able to manage their treatment safely and effectively at home.”
Tina Calvano, a physiotherapist at Barnet Hospital who runs the virtual fracture clinics, said the new system had reduced pressure on the service and improved the experience of many patients.

She said: “A lot of patients think it’s brilliant and are happy not to have to come in. But if a patient has any concerns we will always offer them a face to face appointment if they wish.”

Harold Nwaboku, consultant orthopaedic surgeon, said: “By fast tracking patients to the appropriate specialist, the virtual fracture clinic has dramatically improved the waiting room environment for patients and clinical and clerical staff.”

After nine-year-old Azim Ozedemir injured his wrist playing football six weeks ago, he was taken to Barnet Hospital’s emergency department by his mother Nazan and treated by the virtual fracture clinic.

Mrs Ozedemir said: “We went to the emergency department where we were quickly seen and given an x-ray. They said that it was probably a fracture and gave Azim a splint and said we could go home.

“They called to say they had reviewed the x-ray and that it was a fracture, but that there was no need to come in. They gave me some information and said it would get better on its own. 

“I was very happy. It was convenient not having to go back to the hospital, and Azim’s wrist seems to have healed well. We’re due to take off the splint on Saturday."

Image: X-ray of fractured metatarsal

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About the Royal Free London NHS Foundation Trust

The Royal Free began as a pioneering organisation and continues to play a leading role in the care of patients. Our mission is to provide world class expertise and local care. In the 21st century, the Royal Free London continues to lead improvements in healthcare.

The Royal Free London attracts patients from across the country and beyond to its specialist services in liver and kidney transplantation, haemophilia, renal care, HIV, infectious diseases, plastic surgery, immunology, Parkinson's disease, vascular surgery, cardiology, amyloidosis and scleroderma and we are a member of the academic health science partnership UCLPartners.

In July 2014 Barnet Hospital and Chase Farm Hospital became part of the Royal Free London. Read 'A bigger trust, a better future'.