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Virtual Fracture Clinic plans for patient portal



Brighton and Sussex University Hospitals Trust is using Dynamics 365 to add a new dimension to its care for patients with bone fractures

Three years ago Brighton and Sussex University Hospitals Trust set up the Virtual Fracture Clinic allowing patients to avoid unnecessary – and painful – trips to the hospital for face-to-face assessments.

Before then, patients would have arrived at A&E with a broken bone then returned for a follow-up appointment with a consultant. Now, patients referred to the virtual clinic from A&E receive information about managing their injury at home via videos and PDFs online, with support from specialists through video messages and by telephone.

Some 57% of patients referred to the trailblazing clinic have avoided a return to hospital. Patients who do return, says Lucy Cassidy, the trust’s advanced practice physiotherapist, come back at the right time to see a specialist in the relevant area, making it more likely they can resolve unanswered questions and obtain better targeted treatment.

"It's all about receiving the right care, at the right time under the correct specialist," she says.

“Traditionally, if someone breaks a bone, they go to A&E then come back a few days later to be told they have a fracture or to receive very little extra information,” Cassidy says."All patients came back to see the on-call consultant who did not necessarily specialise in their injury."

Previously, it was a lottery for the patient, dependent on the day of the week and which healthcare professional you they saw. “So we looked at introducing changes to bring the patient to the centre of care.”


The clinic has achieved some impressive results – at £67 the cost of a virtual referral is half that of a traditional appointment and it has saved the NHS over £750,000 – but the physiotherapy team wanted a slicker, more reliable system to track and record patient progress. They wanted to improve the patient experience and access to information, and make reporting and tracking patient information more efficient for staff.

“Upscaling technology in the NHS is very difficult without a platform in place, so we started to apply for awards for leverage to get into the big game,” Cassidy says.

The applications paid off: this year, the Virtual Fracture Clinic won the NHS Challenge Award for best practice adoption and Cassidy won the Advancing Healthcare Awards for entrepreneurship and as overall winner.

The team now has a portal based on Dynamics 365 to better record and track patients’ injuries and action plans.

In the past, they have used “any free software we could get our hands on” and a form to export data to an Excel spreadsheet within the hospital intranet. Patients were directed to self-management videos on YouTube and PDF rehabilitation guides via email.

“It worked reasonably well,” says Cassidy, but the process was “haphazard and not very proficient or professional.” 

“There was always a problem with data management. With Excel spreadsheets, if someone accidentally deletes a cell, it’s gone for good. If you share it or if someone adds to it, you always need to check who last edited it. It has no time stamps, so there’s no way to tell when it’s been changed. If staff were good at Excel, it was a bonus. If they weren’t, you could lose data.”

Automated tracking

With Dynamics 365 in place, patients will automatically receive a link to the portal following their initial visit to A&E, where they can log in and access generic injury management advice on how to fit a sling or use crutches, and to self-monitor at home.

“While they are waiting for their diagnosis, they can help themselves,” says Cassidy.

Once an injury management plan is in place, Dynamics 365 automatically sends a second email to the patient inviting them to access a more tailored rehabilitation plan by logging in to the portal.

"After the ward round of the Virtual Fracture Clinic consultant, 24-48 hours later, the portal will be populated with an injury management plan and outcome measures specific to the injury, with auto reminders at the correct stages to move on with their rehabilitation.

It will also help the team to track recovery and enable any amendments to the plans. Once diagnosed, patients log in to a survey as if it were the day before the injury and following at six weeks, three months and a year. They provide the data to enable physiotherapists and orthopaedic consultants to gauge how well they are doing and follow up accordingly".

Monitoring recovery

But patients are not left completely to their own devices. The portal allows clinicians to see if recovery is not progressing well and if necessary enables them to make an appointment.

According to Cassidy: “If the patient is slipping below expected levels for recovery, we can take action based on the data that the patient submits."

What of the not-so-tech savvy patient? “If people are not happy being managed virtually, or if they’re on a self-management programme but struggling, they can make an appointment. There’s an open door policy,” she says.

Because Dynamics 365 is configurable, a third party company removed any unnecessary features, leaving it “stripped of anything that could go wrong.” The system also collects useful reporting insights, including patient satisfaction and other evaluation data.

“A dashboard facility calculates hit rates from diagnosis from A&E to us,” says Cassidy. “We ask A&E for a diagnosis now and the hit rate is percentage matched with our Virtual Fracture Clinic diagnosis. We had to manually go through the spreadsheet to do this, but now the reporting function happens more quickly. It’s more automated.”

“This is a great training resource and provides valuable information audit, which is something we would never have had time to manually collect before and the bonus is its all automated.”

The dashboard also automatically calculates information that the team must report on, such as the number of patients requiring follow-up, which clinic and timeframes, allowing staff to accurately predict the number of slots they need to provide.

Data safety

Cassidy now plans to provide some basic training to staff on the use of Dynamics 365, and says she no longer has to worry about accountability and errors in editing patient information.

“Dynamics 365 uses unique log-ins, so it tracks who made a change. That will be really useful. Dynamics 365 is a lot safer in terms of storage of data.”

One of the trust’s motivations for choosing Dynamics 365 was to avoid duplication of effort, and there is scope to expand the use of the portal beyond the Sussex boundaries.

“It’s a proof of concept. If it works well, we’ll link it to other hospital systems,” Cassidy says.

Already 10 acute trusts have expressed an interest in linking their systems to the portal, which went live this month.

“They can now use the technology with a different front-facing referral form, instead of having to configure their own system,” she concludes.

If you'd like to hear more, Lucy will be speaking at two forthcoming events; Innovation Nation on 8th February and Taking Virtual Clinics from concept to completion on 27th February. Click on the relevant link to register.

Image by Jojo CC-BY-SA-3.0 via Wikimedia Commons

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