Virtual Fracture Care in Long-Term Care Homes Avoiding Emergency Department Visits.
Genny Ng, Jeremie Larouche, Sid Feldman and 4 others
PMID 36898412WHAT IT FOUND
In 17 long-term care referrals, all residents avoided emergency department transfer, and 47% avoided fracture clinic transfer.
Trained LTC nurses and physiotherapists stabilized injuries on site, but this is a small quality improvement report, not proof the pathway works.
Key findings
01Across 17 referrals, all LTC residents avoided transfer to the emergency department.
0247% of residents avoided transfer to the fracture clinic because surgeons provided virtual guidance to on-site staff.
03Chart audits found no critical changes to injury management within 14 days and no uncontrolled pain after injury.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The report included only 17 referrals and does not describe a comparison group, so it cannot show that the pathway caused the avoided transfers. The authors state that strong evidence does not yet exist and that a more fulsome evaluation is needed. Severe fractures and complications were excluded, so the findings do not apply to hip fractures, open fractures, shoulder dislocations, large deformities, neurologic compromise, uncontrolled pain, or compartment syndrome. The pathway required mobile radiography, on-site splints and braces, trained staff, virtual care processes, and nurse navigator support, which may not be available in all homes. Some homes not enrolled in the pathway erroneously ordered urgent radiographs and used the flag for nonmusculoskeletal requests, indicating implementation problems.
The easy way to misread this
Do not conclude that this pathway is proven to reduce emergency department visits or is safe for all fractures. Only 17 referrals were reported, the report does not describe a comparison group, and severe injuries were excluded. The authors state that strong evidence does not yet exist.