10 November 2017

Reduced DNAs and improved patient satisfaction at Preston’s new virtual clinic


  • Long delays between patients leaving A&E to patients attending a clinic appointment
  • Complex scheduling, resulting in a large volume of Did Not Attends (DNAs) and unnecessary appointments


  • Implementation of Bluespier’s Virtual Fracture Clinic module


  • Streamlined clinic management
  • Improved patient experience through reduced waiting periods
  • DNA rates reduced, providing significant cost savings

The full study

NHS Fracture Clinics in the U.K. are notoriously busy. The services are led by a team of consultants with a team of registered nurses, healthcare assistants, plaster technicians and clerical staff, often treating thousands of patients every year who have visited A&E with a suspected fracture.

At Lancashire Teaching Hospitals NHS Foundation Trust, the hard working staff, were dealing with large patient throughput, leading to long wait times from patients visiting A&E to attending the initial fracture clinic appointment.

Jackie McEvoy, Performance & Capacity Manager, said: “Our traditional fracture clinic at both our Royal Preston Hospital and Chorley District hospital sites were running at a 10 day lead-time from patients leaving A&E to patients attending a clinic appointment. We analysed that many patients were arriving at clinic without requiring any treatment at all. A large volume of appointments also resulted in DNAs from patients who felt better after a long wait but did not cancel.”

“We realised that by improving the discharge rate from A&E and streamlining the way the clinic was managed, we could not only see patients faster from A&E but also reduce DNAs, create financial efficiencies and improve patient experience.”

Mapping requirements

Initially, a projects team from Lancashire Teaching Hospitals NHS Foundation Trust visited Glasgow Royal Infirmary, who pioneered the virtual clinic process with Bluespier in 2010. The hospital had mapped out an alternative to the traditional fracture clinic process – a safe and effective way of improving patients’ experience while reducing demand on the service.

Jackie said: “Visiting another site was really important. The team at Glasgow were able to share best practices, their own lessons learned and also ways to track and monitor success so we could ensure that any process change we implemented could be analysed. They also showed how using Bluespier helped create efficient administration processes and ensured all patient information is available to the right clinician at the right time – a vital element to the virtual clinic’s success.”

Going virtual

The quest to go ‘virtual’ started with refining core processes. Firstly, the workflow at A&E was refined to improve direct discharge and reduce unnecessary follow ups to fracture clinic.

Jackie McEvoy explained: “The first hurdle was ensuring that only patients who really needed to be in the virtual fracture clinic were sent there. Patients’ who did not, were given detailed patient care information by A&E and avoided unnecessary return trips – time off work, childcare, parking and general travel time – which we knew would have a positive impact on patient experience, as well as waiting lists. Four months since going live, 99% of all discharge decisions are correct.”

With A&E processes refined, the project team looked at the management of the clinic itself. Dedicated clinic nurses and administration staff are responsible for calling every patient scheduled for a follow up within 24 hours, organising an appointment to suit the patient and booking these appointments on to the Bluespier Virtual Fracture Clinic. Patients are encouraged to ask questions and have the opportunity to turn down appointments should their symptoms improve.

Amanda Mepstead, Sister, Fracture and Orthopaedic Clinic said: “Patients are really reassured by being able to discuss their symptoms and the fracture clinic process with a member of staff over the phone. We have all the correct information to hand in Bluespier, ensuring we can give the right advice and have the full context regarding the patient’s injury. As well as being positive for patient experience, it also is helping us reduce DNAs which were very costly to the Trust.”

Right care, right time, right medical professional

All patients referred by A&E are reviewed virtually by a consultant and a fracture clinic nurse whilst the patient remains in the comfort of their own home. An outcome is determined, either discharge with advice or review in clinic, and recorded in Bluespier so the appropriate clinical staff can access the right information quickly and easily.

The patient is telephoned by the nurse with the follow up treatment and injury plan. The Bluespier assessment, with completed information from the consultant, is then used to generate a template letter for the patient too – saving considerable administration time and duplication.

The impact

The virtual fracture clinic has completely changed the service at Lancashire Teaching Hospitals NHS Foundation Trust.

Caroline Slater, Sister, Fracture and Orthopaedic Clinic said: “We have considerably improved patient satisfaction and speed of patient care. Patients are no longer waiting for long periods in clinics and feel better supported from home. When they are discharged from A&E, they know when they will be expecting a phone call, what the next steps will be and how the care plan will be decided and communicated. It takes away any ambiguity or uncertainty for the patient.”

In addition to improvement of patient satisfaction, there has also been a dramatic improvement in financial and operational efficiencies.

Within the first four months, the Trust has significantly decreased the rate of DNA appointments in comparison to the same time period the previous year. This is an important area of success. Some Trusts can find it a challenge to initially financially justify a virtual clinic as the virtual appointments do not generate as much revenue as face to face appointments. However, when taking into account the significant savings made from reduced DNA rates and also the administration efficiencies created by using Bluespier, the service ticks all the boxes in relation to positive change: improvement in patient care, directly impacting on patient satisfaction, better utilisation of resources and staff and creating cost savings.

Stuart van Rooyen, Managing Director at Bluespier said:We are really delighted with the Virtual Fracture Clinic project and our ongoing relationship with the clinical and IT teams at the Trust, who drove the initiative from the very start. We are consistently championing digital innovation within healthcare, and for us, the Virtual Fracture Clinic model is a shining example of how these process changes underpinned by excellent software can simply and effectively transform patient care delivery.”

To find out more about Bluespier’s Virtual Fracture Clinic, watch our video, visit or call 0333 014 6262. Bluespier International is part of the Clanwilliam Group.