253 Virtual Acute Shoulder (VAS) Clinic in University Hospital Crosshouse (UHC): Developing a New Pathway and Delivering Cost-Effective Patient Care in Compliance with British Orthopaedics Association (BOA)

Abstract

Abstract Aim Setting up this model reduces the waiting time for specialty review of shoulder fractures, provides a timely management plan which would eventually lead to a better patient journey and outcome. Method A retrospective 3-cycles QIP of the shoulder fracture clinic in UHC from Jan 2020 - May 2022. We analysed the outcomes of these patients; number of telephone reviews, hospital review appointments, number added to the trauma list for intervention and/or discharged and the cost-benefit analysis. Results In 2020 VAS was introduced, out of 383 scheduled patients 14.36% (55) of them were virtual appointments. This percentage increased to 40.17% (188) in 2021 and 42.06% (53) so far in 2022. All of the VAS attendances met the 4-hour A&E target and did not require admission. All patients were contacted by an advanced physiotherapy practitioner following virtual review of clinical notes and radiographs by the senior author within 7 days. The VAS model saved at least £5500 (2020), £18,800 (2021) and £5300 (2022) by avoiding physical appointments and admissions. In addition, we avoided unnecessary preoperative admission and repetition of outdated COVID-19 PCR tests which saved additionally up to £1660 since 2020, this is because all operations (56) were allocated to designated sub-specialty trauma lists. Conclusions UHC pioneered a new VAS model in times of rising pressures and financial constraints to manage all shoulder fractures attending A&E; including injuries that potentially require surgery. It reduced unnecessary outpatient appointments, admissions and provided specialist input in a timely manner (right person, right time).