Utilization of a self-removable orthoses and a comprehensive app, Virtual Fracture Care enables direct discharge of patients with simple stable injuries, reducing outpatient visits by 92%.
Pitch Initiative:
Prior to the implementation of the Virtual Fracture Care project, patients with these 11 simple stable injuries would be followed-up in the outpatient department, usually involving one or two appointments, cast-removal, and some instructions. After the VFC project, patients are put in self-removable orthoses, and receive all information regarding their injury and recovery in the Emergency Department. All this information is also summarized in the VFC app, that also contains videos and exercises to improve recovery. Patients can contact a telephone helpline in case of concerns or problems. Standard/routine follow-up appointments are no longer scheduled.
This project was first piloted in the OLVG hospital in Amsterdam. Currently, over 35 hospitals in the Netherlands use the Virtual Fracture Care app and in these hospitals patients are no longer followed-up routinely with one of these injuries. The implementation of the VFC app in the Netherlands has been accelerated by the COVID-19 pandemic, since less face-to-face appointments were deemed necessary. If all hospitals in the Netherlands would implement direct discharge, this would approximately involve 80.000 patients each year.
Our studies show that direct discharge of patients with simple stable injuries decreased the number of outpatient clinic visits by 92%. Furthermore, radiographic imaging is reduced by 75%. Patient-reported outcomes, including patient satisfaction with treatment as well as functional outcome, remained equal before and after the implementation of direct discharge. Moreover, patients missed less work-days and school-days (in case of children) since a follow-up appointment is no longer necessary.
We also performed a cost-effectiveness study and showed that direct discharge of patients with simple stable injuries is a cost-effective alternative to traditional treatment. We estimated that direct discharge decreases healthcare costs by approximately 800€ per patient.
The project does not lead to an increase in general practitioner visits nor physiotherapist visits.
The project is also unique since it provides benefits for all groups involved. I.e., for patients, it leads to less appointments and less missed school and work days, and parking costs, without altering their outcome and satisfaction. For ED physicians, it leads to a more standardized way of providing information to each patients. For ED nurses, it means casts no longer have to be applied, and orthoses take less time to apply. For plaster technicians, their outpatient clinic is less crowded.
Another unique feature of this project is the Virtual Fracture Care app. This app is established around a cooperation between all hospitals involved. It has improved the way hospitals cooperate, for example, several hospitals have shared their videos, leaflets, etc. and hospitals are working together to improve the app. This had led to the last update of the app, that added multi-language functionality, and the app is now available in 5 different languages.