Skip to main content

Advertisement

Log in

Electronic referrals for virtual fracture clinic service using the National Integrated Medical Imaging System (NIMIS)

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Introduction

Virtual fracture clinics (VFC) are now prevalent across many orthopaedic services in the UK and Ireland. The management of a variety of musculoskeletal injuries using the VFC model has been demonstrated to be safe, cost-effective and associated with high levels of patient satisfaction. Referrals were made available through the National Integrated Medical Imaging System (NIMIS). NIMIS allows for electronic movement of patient images throughout the Irish health service.

Methods

A retrospective review of 157 orthopaedic fracture referrals from a regional hospital was performed. The referrals were received during a 6-week period between May 2016 and June 2016. Each of these referrals was sent electronically. These referrals were reviewed each day by a consultant-led multi-disciplinary team.

Results

Thirty (93%) patients agreed or strongly agreed that they received adequate information in relation to the VFC when they attended the emergency department (ED). All patients except for one either agreed or strongly agreed that they were satisfied with their recovery (97%). Fifteen parents advised us that they would have had to take time off to attend fracture clinic with their child. Two patients attended their general practitioner (GP) or ED to seek further pain relief following their injuries. Only one patient reported a poor clinical outcome. Nine (28%) patients reported that they would have preferred a face-to-face appointment rather than being treated by the VFC.

Conclusion

Virtual review of orthopaedic trauma patients results in satisfactory patient outcomes. Clinical outcomes were acceptable with minimal additional medical attention required following injury. Electronic transfer of information allows for the virtual service to operate from sites long distances from the primary orthopaedic centre. The NIMIS is a safe and confidential means of collaborating with other institutions and has huge potential in the areas of trauma care delivery, clinical conferencing and other image-based disciplines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Gamble D, Jenkins PJ, Edge MJ, Gilmour A, Anthony IC, Nugent M, Rymaszewski LA (2015) Satisfaction and functional outcome with “self-care” for the management of fifth metacarpal fractures. Hand (N Y) 10(4):607–612

    Article  Google Scholar 

  2. Bhattacharyya R, Jayaram PR, Holliday R, Jenkins P, Anthony I, Rymaszewski L (2017) The virtual fracture clinic: reducing unnecessary review of clavicle fractures. Injury 48(3):720–723

    Article  PubMed  Google Scholar 

  3. Vardy J, Jenkins PJ, Clark K, Chekroud M, Begbie K, Anthony I, Rymaszewski LA, Ireland AJ (2014) Effect of a redesigned fracture management pathway and ‘virtual’ fracture clinic on ED performance. BMJ Open 4(6):e005282

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bellringer SF, Brogan K, Cassidy L, Gibbs J (2017) Standardised virtual fracture clinic management of radiographically stable Weber B ankle fractures is safe, cost effective and reproducible. Injury 48(7):1670–1673

    Article  CAS  PubMed  Google Scholar 

  5. McKirdy A, Imbuldeniya AM (2017) The clinical and cost effectiveness of a virtual fracture clinic service: an interrupted time series analysis and before-and-after comparison. Bone Joint Res 6(5):259–269

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Anderson GH, Jenkins PJ, McDonald DA, van der Meer R, Morton A, Nugent M, Rymaszewski LA (2017) Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital. BMJ Open 7(9):e014509

    Article  PubMed  PubMed Central  Google Scholar 

  7. Robinson PM, Sim F, Latimer M, Mitchell PD (2017) Paediatric fracture clinic re-design: incorporating a virtual fracture clinic. Injury 48(10):2101–2105

    Article  PubMed  Google Scholar 

  8. Ferguson KB, McGlynn J, Jenkins P, Madeley NJ, Kumar CS, Rymaszewski L (2015) Fifth metatarsal fractures - is routine follow-up necessary? Injury 46(8):1664–1668

  9. Holm A, Lurås H, Randsborg P (2016) The economic burden of outpatient appointments following paediatric fractures. Injury 47(7):1410–1413

    Article  PubMed  Google Scholar 

  10. Morris M, Bell M (2006) The socio-economical impact of paediatric fracture clinic appointments. Injury 37(5):395–397

    Article  CAS  PubMed  Google Scholar 

  11. Mark D, Fitzmaurice G, Haughey K, O’Donnell M, Harty J (2011) Assessment of the quality of care and financial impact of a virtual renal clinic compared with the traditional outpatient service model. Int J Clin Pract 65(10):1100–1107

    Article  CAS  PubMed  Google Scholar 

  12. Rathod D, Win T, Pickering S, Austin M (2008) Incorporation of a virtual assessment into a care pathway for initial glaucoma management: feasibility study. Clin Exp Ophthalmol 36(6):543–546

    Article  PubMed  Google Scholar 

  13. Hunter J, Claridge A, James S, Chan D, Stacey B, Stroud M, Patel P, Fine D, Cummings JRF (2012) Improving outpatient services: the Southampton IBD virtual clinic. Frontline Gastroenterology 3(2):76–80

    Article  PubMed  PubMed Central  Google Scholar 

  14. Court J, Austin M (2015) Virtual glaucoma clinics: patient acceptance and quality of patient education compared to standard clinics. Clin Ophthalmol:745

  15. Trikha S, Macgregor C, Jeffery M, Kirwan J (2012) The Portsmouth-based glaucoma refinement scheme: a role for virtual clinics in the future? Eye 26(10):1288–1294

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kotecha A, Brookes J, Foster P, Baldwin A (2015) Experiences with developing and implementing a virtual clinic for glaucoma care in an NHS setting. Clin Ophthalmol:1915

  17. Kotecha A, Bonstein K, Cable R, Cammack J, Clipston J, Foster P (2015) Qualitative investigation of patients’ experience of a glaucoma virtual clinic in a specialist ophthalmic hospital in London, UK. BMJ Open 5(12):e009463

    Article  PubMed  PubMed Central  Google Scholar 

  18. J Smith, HK Kok, WC Torreggiani. Examining the end-user experience of the National Integrated Medical Imaging System (NIMIS). Irish Medical Journal January 2016 Volume 109 Number

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Oisin Breathnach.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest. The research complied with all ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Breathnach, O., O’Reilly, M., Morrissey, K. et al. Electronic referrals for virtual fracture clinic service using the National Integrated Medical Imaging System (NIMIS). Ir J Med Sci 188, 371–377 (2019). https://doi.org/10.1007/s11845-018-1901-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-018-1901-3

Keywords

Navigation