757 Rapid Deployment of a Virtual Fracture Clinic (VFC) at a London District General Hospital: Safely Building on a Pragmatic Measure to Bring About Lasting Service Impact

Aim We report our experience of rapidly deploying a Virtual Fracture Clinic (VFC) at our institution as a safe alternative to a traditional fracture clinic and demonstrate how innovation can be built upon to enact lasting change. Method The VFC was assessed using 3 PDSA cycles. Initially, a paper referral system was established along with detailed injury management pathways. In the 2nd PDSA cycle an electronic referral system was introduced. The 3rd PDSA cycle involved ED staff training sessions, alongside a patient webpage. At each stage the number of VFC referrals, clinic follow-ups and patient satisfaction were measured. Results There was a statistically significant (p-value<0.01) reduction in the number of new face-to-face follow-up appointments between pre-VFC (4083) and post-VFC (713); an increase in patient satisfaction (p-value<0.05) and a reduction in non-attendance (p-value<0.01). Recent executive review demonstrated ongoing success and sustainability with the creation of 1600 face-to-face clinic slots which could be used for elective or post-op patients, reducing the pressure on orthopaedic services. Conclusions We have demonstrated that a VFC model can be deployed rapidly and safely as an emergency measure and subsequently refined into a permanent and effective service thereby dramatically improving efficiency and cost effectiveness over a short period. Rapid, bold innovation is possible in the NHS but requires short-term pragmatic changes which can then be nurtured to amplify their lasting effect. Our work highlights that key to success are strong clinical leadership, the meaningful engagement of all stakeholders and senior managerial/operational support.