Aim: To evaluate the efficacy and safety of a novel spine virtual fracture Clinic (SVFC) in a major tertiary trauma hospital.
Methods: A study was conducted comparing outcomes prior to (January to December 2021) and
following (July 2022 to November 2023) implementation of SVFC at The Royal Melbourne
Hospital. The primary aim was to investigate the effects of a telephone-based SVFC on outpatient
clinic activity, represented by the proportion of referrals discharged without requiring in-person
clinic attendance. Secondary aims included comparing SVFC outcomes with traditional outpatient
clinics (appointment utilisation, loss to follow-up rates, and duration of
care) and SVFC safety measured by the number of missed or misdiagnoses, unplanned
operations, and complications. Referrals were ineligible for the SVFC if any of the following
criteria applied: unstable fractures, pathological fractures, reported neurological symptoms, or
pregnancy.
Results: A total of 91.9% (n=666) of referrals managed by the SVFC were discharged without inperson
clinic attendance. Compared to outpatient clinic management (n=150 referrals), SVFC
implementation was associated with reductions in the average number of consultations per
referral (1.8 versus 2.4, p<0.001), appointments not attended (5% versus 13%, p<0.001),
referrals lost to follow-up (0 versus 10.7%, p<0.001) and a shorter duration of care (median 48
days versus 58 days, p<0.001). A total of 65 patients (8.1%) were redirected to in-person clinics,
three of whom underwent surgical intervention, demonstrating that the SVFC does not substitute
for in-person care when required. No diagnostic errors, complications or adverse events were
identified.
Conclusion: This study demonstrates that an SVFC is an effective and safe alternative
management pathway for spine fractures with a low risk of adverse outcomes.