Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
This project implemented a physiotherapy-led fracture clinic to streamline access to appropriate management for patients with injuries not requiring orthopaedic review.
Dates: September 2024 - October 2025
Implementation sites: Royal Brisbane and Women's Hospital
This project was presented as a Poster at CEQ Showcase 2026 (PDF 2.5MB).
Aim
To evaluate the outcomes of a physiotherapist-led fracture clinic (PLFC) implemented to provide access to timely, evidence-informed acute physiotherapy care for patients at RBWH with simple orthopaedic conditions.
Outcomes
- 313/380 (82.4%) attended an offered appointment (Sept 2024-Oct 2025). Only 15 patients (3.9%) opted out.
- 93.3% required no orthopaedic input, indicating safe patient selection and risk management
- Patients attended an average 1.12 appointments. Average wait time to clinic appointment was 16.9 days.
- No adverse events or formal complaints were reported.
- 12 patients (3%) identified as Aboriginal and/or Torres Strait Islander, with 2 failure-to-attend (16.6%) compared to 7% of non-indigenous patients.
- 102 (26.5%) telehealth consultations were conducted, enhancing accessibility and timeliness.
- The operational cost was calculated as $97,625.49. An equivalent orthopaedic-led fracture clinic model was estimated to be $134,730.85, ($37,105.36 saving to the healthcare system ($34,251.10 annually)).
Background
The Royal Brisbane and Women's Hospital Orthopaedic Fracture Clinic is an outpatient clinic providing services for both simple and complex orthopaedic conditions. The clinic serves patients locally in the Metro North Catchment as well as state-wide in Queensland, seeing >300 patients weekly. While many of these patients require specialist input, the clinic also reviews simple cases such as foot and ankle fractures that could be appropriately managed by an experienced musculoskeletal physiotherapist without orthopaedic input. A physiotherapist-led fracture clinic (PLFC) could potentially provide effective care for these patients that is cost saving and more efficient, while also providing more timely access to definitive conservative care.
Methods
A needs analysis was firstly undertaken to identify:
i) in-scope orthopaedic conditions;
ii) individual physiotherapist requirements; and
iii) likely referral volume based on ICD-10 codes and referral rates.
This culminated in implementation of 0.4FTE senior outpatient physiotherapist with high level knowledge in musculoskeletal physiotherapy and physiotherapy specific radiology training, with in-scope conditions determined to include simple foot/ toe fractures, Weber A fractures, Grade I-II ankle sprains, or first time patellar or shoulder dislocations. Referral pathways were developed in consultation with physiotherapy and orthopaedic to ensure appropriate governance and processes. Consumer needs were considered through an opt-out process while patients additionally provided feedback on consumer information sheets for the clinic.
The quality of the service was determined using indicators mapped to domains from the QH HEALTH32 Consumer Safety and Quality Strategy1: Safe (number of adverse events, number of patients returned to orthopaedics or escalated care), Effective (number of patients managed through service), Consumer-centred (number of patients electing to receive care through PLFC), Timely (average wait time; Proportion of Telehealth appointments), Efficient (average number of PLFC appointments; Healthcare system cost savings), and Equitable (Aboriginal and Torres strait Islander outcomes).
Discussion
The Physiotherapy Led Fracture Clinic has demonstrated strong performance in safety, efficiency and cost effectiveness within its first year of operation. The low escalation rate, absence of adverse outcomes, and significant cost savings confirm that musculoskeletal physiotherapists can safely and effectively manage simple acute orthopaedic conditions within a structured governance framework. The PLFC has reduced demand on orthopaedic outpatient services, enhanced timely access to conservative care, and provided patients with greater choice in their management.
Based on the initial success, further orthopaedic conditions have been included within the scope of the clinic (toe fractures) and additionally accepting appropriate referrals from out of catchment. The model of care is also undergoing review for adaptation and implementation into a similar service for hand conditions.
Opportunities for further development include continued refinement of referral pathways, ongoing clinician education to reduce inappropriate referrals, and strategies to improve access and engagement for Aboriginal and Torres Strait Islander patients.
References
- Queensland Health HEALTH32 Consumer Safety and Quality Strategy 2032. Available at https://www.health.qld.gov.au/system-governance/strategic-direction/plans/consumer-safety-and-quality-strategy-2032. Accessed 26/02/2026.
Key contact
Sarah Featherston
Senior Physiotherapist
Metro North Hospital and Health Service