Virtual Fracture Clinic (V-FRAC) and Paediatric Virtual Fracture Clinic (P-VFRAC)

This document is a summarised version of Allied Health DG-CC4 Virtual Fracture Clinic (V-FRAC). The summary has been created to be Emergency Department specific, and has been endorsed by the ED Leadership Team and Physiotherapy Team. Staff should review the PPG if they require further information.

Overview

This QRG provides an overview of the V-FRAC and P-VFRAC services, including eligibility criteria and how to refer to the service from the Emergency Department (ED).

Applicability

This QRG is applicable to all SHED clinical staff.

Responsibility

The Nurse Unit Managers and Directors are responsible for ensuring that all relevant staff are appropriately aware of the V-FRAC and P-VFRAC service.

Guideline/Process Details

Virtual Fracture Clinic

The Virtual Fracture Clinic (V-FRAC) and Paediatric Virtual Fracture Clinic (P-VFRAC) services are run by specialist Advanced Practice Physiotherapists working in conjunction with Orthopaedic Surgeons to provide safe and timely care for patients after they have suffered a fracture or soft tissue injury. Western Health currently runs a Virtual Fracture Clinic service for both adults (V-FRAC) and children (P-VFRAC).

Patients are referred directly from ED to VFRAC where each case is reviewed and triaged to either a virtual consult or fracture clinic to be seen face to face. Not all patients will have a virtual consult.

Patients who are appropriate for a phone consult with V-FRAC will be provided with a definitive management plan, detailed injury management information and opportunity to discuss any concerns.

Who should be referred to V-FRAC or P-VFRAC by ED clinicians?

ED patients with fractures or soft tissue injuries requiring Orthopaedic opinion
- ≥ 18 years old – VFRAC
- <18 years old = P-VFRAC
Patients will then either have a virtual consult or will be contacted by administration to arrange ongoing management (e.g. fracture clinic appointment)
FirstNet – Medical referrals to outpatient clinic

Who should not be referred to V-FRAC or P-VFRAC from ED?

Patients with minor soft tissue injuries – these can be managed via the GP (eg. ankle sprain, wrist sprain, calf strain etc.)
Patients who are being admitted – home team should follow up with orthopaedics from the ward.
Hand injuries beyond proximal carpal row – refer to plastics
Chronic conditions requiring an Orthopaedic opinion (e.g. severe OA) – refer to Orthopaedics via EMR e-referral

When should ED clinicians call Orthopaedic registrar on call?

Continue to call the Ortho Registrar on call via switch in regards to any patients requiring immediate Orthopaedic intervention.

Useful Resources

Visit the VFRAC intranet page for resources including:
- ED clinician guide
- ED clerk guide
- Condition management guidelines
- Patient information handouts specific to WH ED patients

Intranet page: http://inside.wh.org.au/departmentsandservices/virtual_fracture_clinic/Pages/default.aspx

Flowchart of VFRAC/P-VFRAC patient pathways

FAQ's

What should the ED clinician tell the patient on discharge post VFRAC/P-VFRAC referral?

You have been referred on to our Virtual Fracture Clinic service
The team will review your case and decide whether you can be managed via a phone consult or whether you need a face to face appointment.
You should receive a call within 3 business days (for adults) or 4 business days (for paeds) on the number you have provided (ED Clinician should check phone number is correct)
If you don’t receive a call after 4 days, please call number on this letter (ED clinician provides VFRAC/P-VFRAC letter)

Will all patients have a virtual appointment to discuss their management plans?

No, some patients will not be appropriate for a virtual appointment and will be booked to fracture clinic post VFRAC/P-VFRAC triage.
Their management plan will be discussed at their face to face appointment- not on the phone.

What should the ED Clinician do if the Ortho Registrar has identified a specific fracture clinic date for the patient to attend?

Refer via the ED Clerk as usual, and record the requested clinic date in your clinical notes. VFRAC/P-VFRAC will read your notes and book patient to this date.
Do not fax a referral or refer via BOSSnet to # clinic as these will not be accepted- all fractures or acute soft tissue injuries requiring an orthopaedic opinion must be referred via VFRAC.

Questions? Contact Us

Adult Virtual Fracture Clinic
- 0481916095 or fracturecare@wh.org.au

Paediatric Virtual Fracture Clinic
- 0435 467 632 or childrensfracture@wh.org.au

Supporting Documents

Document Governance

Title:	Virtual Fracture Clinic (V–FRAC) and Paediatric Virtual Fracture Clinic (P-VFRAC)
Version:	2.0
Date Published:	June 2021
Date of scheduled review:	01/09/2025
Author: Jordan Lakin		Approver: Shed leadership team & Physiotherapy Team.
Reviewed by: Ian Law		Date: 25/08/2023

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