A Virtual Trauma Assessment Clinic (VTAC) is an innovative, patient-centred initiative designed to speed up access to orthopaedic trauma care. A consultant and physiotherapist-led VTAC was introduced to St James’s Hospital in May, 2021.

A Virtual Trauma Assessment Clinic (VTAC) is an innovative, patient-centred initiative designed to speed up access to orthopaedic trauma care. A consultant and physiotherapist-led VTAC was introduced to St James’s Hospital in May, 2021.

The VTAC team includes orthopaedic consultants, a clinical specialist physiotherapist, a senior physiotherapist and a clerical officer. As clinical specialist physiotherapist in the service, I feel fortunate to be involved in the implementation of this patient-centred Modernised Care Pathway which is improving patient flow and reducing unnecessary fracture clinic appointments.

So how does VTAC work?

Previously, patients attending the Emergency Department (ED) with a broken bone that did not require surgery were referred to a face-to-face fracture clinic. In the VTAC model, a patient’s injury can be reviewed without the patient physically having to attend an appointment at an orthopaedic fracture clinic. Patients arriving to the ED with injuries suitable for the VTAC are provided with a VTAC information leaflet and advised they will receive a follow up phone call.

In the consultant-led VTAC, patient notes and x-rays are reviewed by the doctor and physiotherapist.  Following the review, all patients are contacted directly by a physiotherapist to discuss the appropriate treatment pathway.

During the phone call, patients are provided with information on their injury, recommended treatment, exercises and where appropriate, return to activity advice. They are also provided with the VTAC contact details (phone/email) should further advice or review be required.

What are the benefits of VTAC?

• More timely access to care: wait times reduced from weeks to days
• Safe: evidence-based treatment and rehab protocols are used in VTAC
• Effective: quicker access to physiotherapy
• Increased operational efficiency: VTAC builds capacity in orthopaedic clinics for patients that require a face-to-face appointment, allowing more time for complex patients
• Reduced environmental impact: patients are not required to travel to the hospital for their appointment
• Cost saving: direct cost saving of €436.40 per patient not requiring a face-to-face review

VTAC at St James’s Hospital

The consultant and physiotherapist-led VTAC was introduced to St James’s Hospital in May 2021, initially running two days per week for the first eighteen months. Additional resourcing enabled an expansion of the clinics to five days per week. The service has also evolved to include all stable fractures and dislocations.

In the first year of the expanded service, 1,201 new patients were referred to VTAC. This represents a 238% increase in referrals from 2023. 84% of referrals were reviewed in VTAC within 72 hours of presentation to ED as recommended by the British Orthopaedic Association Standard for Trauma (BOAST).  

56% (n=671) of patients were managed by VTAC without attending a physical appointment in an orthopaedic fracture clinic. These metrics demonstrate the success of this modernised care pathway in delivering efficient and effective orthopaedic trauma care at St James’s Hospital.