Virtual Fracture Care Pathway Reduces COVID-19 Exposure Risk for LTC Residents

May 9, 2023

May 9, 2023                                                                                                                                                                                                                                                            Contact: Ellen Mullally  

Emergency Department (ED) visits and hospitalizations can be traumatic for long-term care (LTC) facility residents and put them at risk for issues such as infections. During the COVID-19 pandemic, transfer to the hospital not only increased the risk of COVID-19 exposure but also resulted in extended isolation. An article in the May issue of JAMDA showcased a fracture care pathway developed and implemented to provide rapid diagnostic imaging results and stabilization in the LTC setting, reducing exposure risk to COVID-19.

In Virtual Fracture Care in LTC Homes Avoiding Emergency Department Visits, the authors described a program that allows eligible residents with a stable fracture to receive a referral to a designated fracture clinic for consultation. Fracture care is then provided in the LTC facility by staff. An evaluation of the pathway showed that 100% of residents did not require transfer to the ED and nearly half (47%) did not transfer to a fracture clinic for additional care.

The novel fracture care pathway was developed as part of a program to provide fracture care in the LTC facility. This involved partnering with a mobile x-ray provider for expedited access for LTC residents with a suspected fracture. LTC facilities also were equipped with stabilizing braces and splints that allow staff to immobilize injuries for residents while they await diagnostic confirmation.

Additionally, a referral form was created to allow LTC providers to request a virtual fracture clinic appointment if necessary. The authors noted, “Depending on the type of fracture and care required, the fracture clinic either completes the assessment virtually or schedules an in-person assessment.”

All upper and many lower extremity fractures were included in the pathway, the authors said, as these injuries generally can be managed safely in the LTC setting with the added resources included in the program. Hip fractures, open fractures, and shoulder dislocations—as well as limb injuries with visible large deformities, neurologic compromise, ongoing pain not controlled by analgesia, and/or compartment syndrome—were excluded. “These injuries are more serious and more appropriately managed in the acute care setting if consistent with the resident’s goal of care,” the authors said.

The authors concluded, “Given the high prevalence of injuries leading to fractures in the LTC setting if scaled, this pathway has the potential to significantly reduce avoidable ED transfers from LTC while simultaneously improving LTC resident care experiences.”

This study was conducted by researchers at Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Baycrest Apotex Centre, Toronto, Ontario, Canada; Unity Health Toronto, Toronto, Ontario, Canada; Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada: and Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.

Get more information on the findings above and more details about the study. To contact the researchers or JAMDA editors for an interview, please email




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JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.