Paediatric fracture clinic re-design: Incorporating a virtual fracture clinic Paul M. Robinson a, *, Francis Sim b , Mark Latimer a , Piers D. Mitchell a a Department of Trauma and Orthopaedics, Peterborough City Hospital, North West Anglia NHS Foundation Trust, UK b Department of Trauma and Orthopaedics, The Leeds Teaching Hospitals NHS Trust, UK A R T I C L E I N F O Article history: Accepted 2 August 2017 Keywords: Fracture clinic Service improvement Paediatric Home management Virtual fracture clinic A B S T R A C T Introduction: The use of virtual fracture clinics (VFCs) and home management protocols is increasing. The main aim of this research is to determine whether a paediatric home management programme and VFC can be used safely to manage a range of suitable fractures in children. Materials and methods: Protocols for the home management of stable paediatric fractures were designed by two consultant paediatric orthopaedic surgeons. These were for children between the ages of 18 months and 15 years 364 days. A new tariff was negotiated with the clinical commissioning groups (CCGs) for a VFC new patient review. A prospective analysis was performed for the first 2 months of the programme. Further review periods were undertaken 6 months later and 12 months after that. Results: Sixty-five patients were reviewed in the first 10 VFCs (mean 6.5 cases per week). After 6 months, 164 patients were reviewed in a 3-month period in the VFC, a mean of 11 cases per week. A year later the number of patients reviewed in the VFC had continued to increase with a total of 253 patients in 3 months, mean 21 cases per week. This gave a saving to the CCG of £45,000 per year and to the hospital of £106,000 per year. There were no serious adverse consequences to any patients from the use of the pathway. Discussion and conclusion: We have reported on the introduction of a paediatric VFC and a home management programme for stable paediatric fractures. We are not aware of any reports in the orthopaedic literature that have described such a comprehensive and innovative re-organisation of paediatric fracture services. We estimate that the NHS could save approximately £10.1 million if all hospitals in England introduced this. Crown Copyright © 2017 Published by Elsevier Ltd. All rights reserved. Introduction The use of virtual fracture clinics (VFCs) and home management protocols has evolved and increased over the past few years [1–10]. This has been in response to the drive for improved efficiency, cost savings and a widespread recognition that there are many stable, self-limiting injuries that do not need to be reviewed by a consultant orthopaedic surgeon at a standard face-to-face outpa- tient clinic appointment. Huntley reported that 50% of new paediatric fracture referrals were avoidable and 15% of all paediatric fracture clinic attendances were inappropriate [11]. Similarly, Ramasubbu et al. found that 37% of children’s fracture clinic referrals were made for an injury where there was no fracture seen on the radiographs when reviewed by a consultant radiologist [12]. Home management programmes have been implemented and used successfully in both adults and children with defined orthopaedic injuries [1–10]. In our hospital, most paediatric patients with fractures are seen in a dedicated “children only, child friendly” paediatric fracture clinic by two consultant paediatric orthopaedic surgeons and their team. It was noted that many patients attending the clinic could have been managed safely and adequately at home with a home management protocol and VFC review, with no detrimental effect to the outcome of their injury. For patients of school age this would lead to less time spent out of formal education. There would be less time taken off work for the parent or guardian attending the fracture clinic with the patient, and there would be economic advantages to both the hospital, the parent/guardian and their employer. It was also hypothesised that this would lead to better patient and guardian satisfaction. * Corresponding author at: Department of Trauma and Orthopaedics, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Bretton Gate, Peterbor- ough, PE3 9GZ, UK. E-mail address: paulrobinson79@doctors.org.uk (P.M. Robinson). http://dx.doi.org/10.1016/j.injury.2017.08.006 0020-1383/Crown Copyright © 2017 Published by Elsevier Ltd. All rights reserved. Injury, Int. J. Care Injured 48 (2017) 2101–2105 Contents lists available at ScienceDirect Injury journal homepa ge: www.elsev ier.com/locate /injury