The effects of a Virtual Fracture Care review protocol on secondary healthcare utilization in trauma patients requiring non operative treatment: a retrospective cohort study

Background: The strain on healthcare resources in the Dutch trauma care system is rising. In response, a Dutch adaptation of the Virtual Fracture Care (VFC) review protocol, designed to optimize trauma care quality within resource constraint, has been implemented to sustain high-quality trauma care. This study aimed to evaluate the influence of the VFC review protocol on the utilization of secondary healthcare resources in adult trauma patients who received non-operative treatment for musculoskeletal extremity injuries. Methods: This retrospective cohort study assessed the impact of a VFC review protocol on secondary healthcare utilization in adult trauma patients treated non-operatively for a musculoskeletal extremity injury. Patients treated between July 1, 2018 – December 31, 2019 (pre-VFC group), and January 1, 2021 – June 30, 2022 (VFC group) were included. Outcomes included follow-up appointments and involved healthcare professionals, radiographic imaging, and emergency department (ED) reattendances. Results: A total of 3791 patients were included, comprising 1819 pre-VFC patients and 1972 VFC patients. Following VFC review, the number of follow-up appointments was reduced by 8% and a shift towards remote delivery of care occurred. Furthermore, VFC review led to a 9% reduction in follow-up radiographs and a 29% decrease in ED reattendances. Conclusion: Utilization of a VFC review protocol for management of adult patients with a musculoskeletal extremity injury requiring non-operative treatment improves reduces secondary healthcare utilization compared to traditional treatment protocols. This protocol results in a reduction of follow-up appointments, a transition from face-to-face to remote care delivery, fewer follow-up radiographs, and a reduction of ED reattendances.