Virtual Fracture Care in Long-Term Care Homes Avoiding Emergency Department Visits

Genny Ng; Jeremie Larouche; Sid Feldman; Ashley Verduyn; Sarah Ward; Brian M Wong; Amanda Mayo

doi:10.1016/j.jamda.2023.01.024

Virtual Fracture Care in Long-Term Care Homes Avoiding Emergency Department Visits

J Am Med Dir Assoc. 2023 May;24(5):661-663. doi: 10.1016/j.jamda.2023.01.024. Epub 2023 Mar 1.

Authors

Genny Ng¹, Jeremie Larouche², Sid Feldman³, Ashley Verduyn⁴, Sarah Ward⁵, Brian M Wong⁶, Amanda Mayo⁶

Affiliations

¹ Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Electronic address: Genny.ng@sunnybrook.ca.
² Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
³ Baycrest Apotex Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Unity Health Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Department of Surgery, University of Toronto, Toronto, ON, Canada; Unity Health Toronto, Toronto, ON, Canada.
⁶ Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada.

Abstract

Long-term care residents with suspected fractures as a result of a fall typically transfer to the emergency department (ED) for diagnostic imaging and care. During the COVID-19 pandemic, transfer to the hospital increased the risk of COVID-19 exposure and resulted in extended isolation days for the resident. A fracture care pathway was developed and implemented to provide rapid diagnostic imaging results and stabilization in the care home, reducing transportation and exposure risk to COVID-19. Eligible residents with a stable fracture would receive a referral to a designated fracture clinic for consultation; fracture care is provided in the care home by long-term care staff. Evaluation of the pathway was completed and demonstrated that 100% of residents did not transfer to the ED and 47% of the residents did not transfer to a fracture clinic for additional care.

Keywords: Fracture care; long-term care; orthopedic surgery; virtual care.

MeSH terms

COVID-19*
Emergency Service, Hospital
Humans
Long-Term Care*
Nursing Homes
Pandemics