BOA statement on Virtual Fracture Clinics

The BOA Trauma Group are aware of the development of different models of care for fracture clinic services, such as the Virtual Fracture Clinics that have been introduced in Scotland. NICE, in producing their recent Trauma Guidelines, evaluated the evidence regarding fracture clinic provision but found it insufficient to make any recommendations to change the current model.

It is the BOA’s position that the current BOAST 7 guidelines regarding fracture clinic services still stand and that any change in service or models of care should be audited and evaluated prospectively. Where new services are introduced, adequate safeguards must be put in place to ensure that patients receive appropriate assessment, management, support, information and follow up.

The facility must be available so that any patients deemed appropriate are reviewed by a trauma orthopaedic consultant within 72 hours either directly or by review of the case notes and imaging. When this assessment is non direct then the outcome should be conveyed to the patient by appropriately trained staff who have the option of offering an immediate clinical review if felt necessary.

Some models being looked at involve telephone consultation, where it is thought appropriate by the trauma orthopaedic consultant, who has knowledge of the clinical history. Safe provision of such services would not normally be feasible within the ccurrent tariff structure for a virtual review in the English NHS, and therefore special arrangements will normally need to be made with Trusts and commissioners.

The BOA welcomes research into all aspects of improving patient care and encourages publication of the results of such trials of new fracture clinic models. BOAST 7 is due to be reviewed in two years, by which time further data should be available to update its recommendations and set standards for outpatient management.