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Developing protocols, guidelines, competence and consensus to support the running of the virtual clinic

Lech Rymaszewski, Department of Trauma and Orthopaedics, Glasgow Royal Infirmary discussed developing protocols, guidelines, competence and consensus to support the running of the virtual clinic at today’s conference. In his presentation Lech discussed in-depth:

  • using protocols and guidelines to reduce unwarranted variation
  • developing consensus amongst clinical staff
  • developing protocols and competence including standardised treatment pathways, leaflet supported discharge and a virtual fracture clinic review
  • ensuring accountability and compliance with protocols
  • an overview of our virtual fracture clinics

Lech Rymaszewski full presentation is available for download at the end of this page.

In his presentation Lech Rymaszewski discussed the back ground of Glasgow Royal Infrimary’s road to Virtualization.

From 1993 developed a Musculoskeletal team approach based on triage / extended scope practitioners at Stobhill Hospital, which was then extended to GRI. The redesign was based on establishing transparent, evidence - based clinical processes to improve the quality of care whilst guaranteeing the meeting of targets. Member of National Committees, and was Orthopaedic Specialty Advisor to the Chief Medical Officer of Scotland (2007-10).

In 2010 initiated and developed the “Virtual Fracture Clinic” - a safe and effective redesign process which is patient-focused, clinician-led and does not require additional investment. It is based on collaboration with the Emergency Department and utilises available e-healthcare resources and modern communication methods.  The model is now promoted by the Scottish Government as part of a high impact “Quality Drive”, with the aim of adoption across the whole of Scotland by 2015. The redesign has attracted huge interest throughout the rest of the UK, and even abroad, with many Units at various stages of implementation. It frees up time for clinicians to focus on complex clinical problems, teaching and training. It has received several awards including the 2014 – HSJ - Health Service Journal’s Award for “Acute Sector Innovation”. 

Virtual Fracture Clinic - Glasgow Royal Infirmary

Fracture Clinic Redesign has been patient-focused and clinician-driven - modernising all parts of the process, avoiding unnecessary outpatient appointments and saving time for patients and staff. It is safe, efficient and effective and no additional investment was required. It is based on collaboration - all the Orthopaedic and Emergency Department Consultants agreed protocols for the common injuries, thereby reducing variation.  Evidence-based patient Information leaflets, written in clear, unambiguous language, were essential to reach a consensus.  The protocols promote self-care for appropriate injuries, with an “open-door “policy if the patient fails to progress or wants to be seen at any time.

Following attendance at the Emergency Department (ED) or Minor Injuries Unit (MIU), patients who require orthopaedic review are now booked into a ‘Virtual Fracture Clinic’ instead of automatically attending a traditional clinic.  Here their notes and x-rays are reviewed ‘virtually’ by an orthopaedic consultant on the next day, including weekends and public holidays. The patients are then contacted by a senior nurse on the same day, and are either discharged or, if required, given an appointment to see the appropriate specialist at the appropriate time. The benefit for patients is they now only attend hospital if they need specialist care, allowing staff to deliver a high quality service which was previously difficult to achieve, especially during busy periods. 

The redesign utilises available e-healthcare resources and modern communication methods. Only <40% of non-operative fractures are now seen face-to-face, freeing up time for clinicians to focus on complex clinical problems, audit, teaching and training. We have a real-time database of the non-operative fractures at GRI based on clinical staff recording essential information as part of their daily work. This has facilitated audit of > 1,200 patients, especially with regard to patient outcomes. The model is now being promoted by the Scottish Government as part of a high impact “Quality Drive”, with the realistic aim of adoption across the whole of Scotland by 2015.

All the staff have now embraced the changes with great enthusiasm, recognising that it is in their power to treat patients better.   


Download: Lech Rymaszewski Presentation

20 April 2015

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