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Shammout S, Wall R, Murphy PN, Jain K. Virtual clinics versus face-to-face review: is the benefit the same for new orthopaedic patients? Health Policy 2022; 126:688-692. [PMID: 35644721 PMCID: PMC9122882 DOI: 10.1016/j.healthpol.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
Abstract
Background COVID-19 shocked global healthcare systems, particularly the surgical services, resulting in a significant backlog of patients with waiting times not expected to return to pre-pandemic levels until 2025. The Royal College of Surgeons has recommended a wider use of virtual clinics to meet the increased demand. The efficacy of virtual follow up is well documented in the literature; however, there is very little evidence of the role of virtual clinics in the assessment of new elective patients. Methods Observational study comparing clinical outcomes of new patients electively referred to orthopaedic virtual clinics between January and February 2021 with face-to-face clinics in January and February 2020. Results Over the equivalent time frame, more patients were reviewed in virtual clinics compared to traditional face-to-face (821 vs 499). However, virtual clinics lead to significantly more patients being brought back for follow up (78.3% vs 37.3%) and fewer patients received outcomes that progressed their journey towards a definitive intervention or discharge. Conclusion The overall benefit of virtual clinic appointments in the context of reviewing new patients remains to be proven. Despite increasing use of virtual clinics in the National Health Service, we have shown a potential delay to patients’ clinical progression, ultimately delaying healthcare delivery. Potential methods to improve the benefit of virtual clinics are proposed.
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Pradhan R, Peeters W, Boutong S, Mitchell C, Patel R, Faroug R, Roussot M. Virtual phone clinics in orthopaedics: evaluation of clinical application and sustainability. BMJ Open Qual 2021; 10:bmjoq-2021-001349. [PMID: 34645613 PMCID: PMC8515471 DOI: 10.1136/bmjoq-2021-001349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/05/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Adoption of virtual clinics has been accelerated by the COVID-19 pandemic and they will continue to form an integral part of healthcare delivery. Our objective was to evaluate virtual clinics in orthopaedic practice and determine how to use them effectively and sustainably. METHODS We surveyed 100 consecutive patients participating in orthopaedic virtual phone clinic (VPC) at an academic hospital to evaluate patient satisfaction against face-to-face (F2F) consultations and obtain suggestions for improving patient experience, and we surveyed 23 clinicians who conducted orthopaedic VPCs in 2020. Data were correlated with clinic outcomes, reason for consultation, diagnosis, patient age and clinician grade. Consultation duration, clinician-associated costs and reimbursement were analysed. Significance was tested using two-tailed Student's t-test and Fisher's exact test. RESULTS Patient satisfaction (out of 5) for VPC was significantly lower than F2F (4.1 vs 4.5, p=0.0003), and a larger proportion of VPC scored <3 compared with F2F (11% vs 2%). Higher VPC scores were associated with appointments for delivering results and where patients felt clinical examination was not needed. Patients suggested introducing video capability, adhering to appointment time and offering the choice of VPC or F2F. Mean clinician satisfaction scores for VPC were 4.3/5 and suggested indications for VPC included: routine surveillance, communication of results, discussing/consenting for surgery and vulnerable patients. Integrating video, providing private rooms and offering patients time intervals for VPC were recommended. Current National Health Service VPC structures uses greater clinician resources and generates lower reimbursement than F2F consultations, resulting in 11.5% reduction in reimbursement. CONCLUSION VPC plays a valuable role when clinical evaluation has been performed or considered not necessary. Offering the choice of VPC or F2F, adding video capability and providing a time interval for VPC may reduce resource use and increase satisfaction. We recommend renegotiating VPC tariffs and cost-neutral modifications of clinic structure.
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Affiliation(s)
- Raj Pradhan
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Wouter Peeters
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Orthopaedics, University Hospital Antwerp, Edegem, Belgium
| | - Sara Boutong
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chris Mitchell
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rahul Patel
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rad Faroug
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Roussot
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
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Rhind JH, Devany A, Ramhamadany E, Ismael S, Heaver C, Hill S. Virtual clinics in foot and ankle surgery: patient and clinician perceptions. Ann R Coll Surg Engl 2021; 103:666-672. [PMID: 34432532 DOI: 10.1308/rcsann.2020.7147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The worldwide COVID-19 pandemic has led to the popularisation of 'virtual' clinics. In orthopaedics, little is known about the use of virtual clinics within foot and ankle surgery, specifically. METHODS A cross-sectional observation study of patients and clinicians in response to virtual clinics in foot and ankle surgery. Patients seen in a virtual clinic were contacted by telephone from two weeks after their consultation and asked to complete a 12-point questionnaire. Demographic information was also collected. Clinicians in foot and ankle completed a 10-point questionnaire. RESULTS One hundred patient responses were collected. Patient satisfaction with virtual clinics was positive, with 65% of respondents reporting they were very happy (Likert scale rating 5). More than 90% of patients felt they received enough information, felt involved, felt the virtual clinic was helpful and knew who to contact if there was a problem. However, 79% would still prefer a face-to-face consultation, and 22% would have preferred a video consultation. Clinician responses were more cautious, with 60% stating they were neither happy nor unhappy (Likert scale rating 3). Virtual clinics may be faster for the clinician. CONCLUSIONS Virtual clinics may be more convenient for patients, with high satisfaction levels reported, but represent significant clinical challenges for foot and ankle surgeons. Elements of virtual clinics may persist post pandemic, particularly in routine follow-up. Virtual clinics are not appropriate for new patient referrals.
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Affiliation(s)
- J-H Rhind
- The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| | - A Devany
- The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| | - E Ramhamadany
- The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| | - S Ismael
- The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| | - C Heaver
- The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| | - S Hill
- The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
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Joseph V, Nagy MT, Fountain J. Cost analysis on virtual clinic follow-up after primary joint arthroplasty. J Clin Orthop Trauma 2021; 19:89-93. [PMID: 34046302 PMCID: PMC8144681 DOI: 10.1016/j.jcot.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/28/2021] [Accepted: 05/12/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As previously reported, a virtual clinic (VC) effectively manages the increasing need to review and monitor patients after primary joint replacement. Such procedure is increasing steadily in number, with more than 200,000 procedures performed annually in the UK. Considering that face-to-face review following routine uncomplicated primary joint arthroplasty is costly and time consuming, guidelines suggest reviewing patients at regular intervals through radiographs and patient-reported outcome measures (PROMs). METHODS We reviewed our VC experience in a large teaching hospital. A single surgeon established the VC, and all primary hip and knee replacements over an 18-month period (January 2016 to July 2017) were included in the study. We evaluated all clinical records, PROMs, patient satisfaction, and outcome of VC at one-year follow-up. Additionally, we conducted a safety and cost analysis. RESULTS This study included 154 primary joints (70 total knee replacements and 84 total hip replacements) in 148 patients (89 females, 59 males). The mean age at surgery was 65.3 years. Of the patients, 93% completed the postoperative PROMs, whereas <40% completed the PROM during regular clinical follow-up. All the patients had follow-up radiographs. After VC assessment, which included radiographies and PROMs, 59% of the patients were directly discharged. Of the remaining 41% patients who had face-to-face review, one-third were examined for the same arthroplasty issue, and two-thirds were examined for unrelated or other joint problems. Although the postoperative PROM was below the national average, the improvement in PROM (from pre-operative to post-operative scores) was higher than the national average. The cost analysis demonstrated an average cost savings of £10.449 per year and consultant. CONCLUSIONS VC follow-up after primary joint replacement is a safe and cost-effective option to manage postoperative follow-up visits and identify those patients who require additional face-to-face reviews and who can be safely discharged. The discharge criteria included satisfactory improvement in PROM scores, review of follow-up radiographs, and no concerns raised by patients. Considering the increasing number of primary joint arthroplasty and the financial pressure on the National Health Service, VC offers an excellent alternative to conventional clinics.
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Affiliation(s)
- Vinay Joseph
- Department of Trauma and Orthopaedic Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancashire, WN6 9EP, United Kingdom
| | - Mathias T. Nagy
- Department of Trauma and Orthopaedic Surgery, Aintree University Hospital, Lower Lane Fazakerley, Liverpool, L9 7AL, United Kingdom,Corresponding author. Department of Trauma and Orthopaedic Surgery, Aintree University Hospital, Lower Lane, Liverpool, L9 7AL, United Kingdom.
| | - James Fountain
- Department of Trauma and Orthopaedic Surgery, Aintree University Hospital, Lower Lane Fazakerley, Liverpool, L9 7AL, United Kingdom
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Jenkins JM, Halai M. CORR Synthesis: What Evidence Is Available for the Continued Use of Telemedicine in Orthopaedic Surgery in the Post-COVID-19 Era? Clin Orthop Relat Res 2021; 479:747-754. [PMID: 33724978 PMCID: PMC8083835 DOI: 10.1097/corr.0000000000001444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/14/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Joanne M Jenkins
- J. M. Jenkins, Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK
- J. M. Jenkins, University of Glasgow, UK
- M. Halai, Department of Orthopaedics, University of Toronto, Canada
- M. Halai, Department of Orthopaedics, St Michael's Hospital, Toronto, Canada
| | - Mansur Halai
- J. M. Jenkins, Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK
- J. M. Jenkins, University of Glasgow, UK
- M. Halai, Department of Orthopaedics, University of Toronto, Canada
- M. Halai, Department of Orthopaedics, St Michael's Hospital, Toronto, Canada
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King D, Emara AK, Ng MK, Evans PJ, Estes K, Spindler KP, Mroz T, Patterson BM, Krebs VE, Pinney S, Piuzzi NS, Schaffer JL. Transformation from a traditional model to a virtual model of care in orthopaedic surgery: COVID-19 experience and beyond. Bone Jt Open 2020; 1:272-280. [PMID: 33215114 PMCID: PMC7659667 DOI: 10.1302/2046-3758.16.bjo-2020-0063.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Virtual encounters have experienced an exponential rise amid the current COVID-19 crisis. This abrupt change, seen in response to unprecedented medical and environmental challenges, has been forced upon the orthopaedic community. However, such changes to adopting virtual care and technology were already in the evolution forecast, albeit in an unpredictable timetable impeded by regulatory and financial barriers. This adoption is not meant to replace, but rather augment established, traditional models of care while ensuring patient/provider safety, especially during the pandemic. While our department, like those of other institutions, has performed virtual care for several years, it represented a small fraction of daily care. The pandemic required an accelerated and comprehensive approach to the new reality. Contemporary literature has already shown equivalent safety and patient satisfaction, as well as superior efficiency and reduced expenses with musculoskeletal virtual care (MSKVC) versus traditional models. Nevertheless, current literature detailing operational models of MSKVC is scarce. The current review describes our pre-pandemic MSKVC model and the shift to a MSKVC pandemic workflow that enumerates the conceptual workflow organization (patient triage, from timely care provision based on symptom acuity/severity to a continuum that includes future follow-up). Furthermore, specific setup requirements (both resource/personnel requirements such as hardware, software, and network connectivity requirements, and patient/provider characteristics respectively), and professional expectations are outlined. MSKVC has already become a pivotal element of musculoskeletal care, due to COVID-19, and these changes are confidently here to stay. Readiness to adapt and evolve will be required of individual musculoskeletal clinical teams as well as organizations, as established paradigms evolve. Cite this article: Bone Joint Open 2020;1-6:272–280.
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Affiliation(s)
- Dominic King
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ahmed K Emara
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mitchell K Ng
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Peter J Evans
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kelly Estes
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Thomas Mroz
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brendan M Patterson
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Viktor E Krebs
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Stephen Pinney
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nicolas S Piuzzi
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jonathan L Schaffer
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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7
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King D, Emara AK, Ng MK, Evans PJ, Estes K, Spindler KP, Mroz T, Patterson BM, Krebs VE, Pinney S, Piuzzi NS, Schaffer JL. Transformation from a traditional model to a virtual model of care in orthopaedic surgery. Bone Jt Open 2020. [DOI: 10.1302/2633-1462.16.bjo-2020-0063.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Virtual encounters have experienced an exponential rise amid the current COVID-19 crisis. This abrupt change, seen in response to unprecedented medical and environmental challenges, has been forced upon the orthopaedic community. However, such changes to adopting virtual care and technology were already in the evolution forecast, albeit in an unpredictable timetable impeded by regulatory and financial barriers. This adoption is not meant to replace, but rather augment established, traditional models of care while ensuring patient/provider safety, especially during the pandemic. While our department, like those of other institutions, has performed virtual care for several years, it represented a small fraction of daily care. The pandemic required an accelerated and comprehensive approach to the new reality. Contemporary literature has already shown equivalent safety and patient satisfaction, as well as superior efficiency and reduced expenses with musculoskeletal virtual care (MSKVC) versus traditional models. Nevertheless, current literature detailing operational models of MSKVC is scarce. The current review describes our pre-pandemic MSKVC model and the shift to a MSKVC pandemic workflow that enumerates the conceptual workflow organization (patient triage, from timely care provision based on symptom acuity/severity to a continuum that includes future follow-up). Furthermore, specific setup requirements (both resource/personnel requirements such as hardware, software, and network connectivity requirements, and patient/provider characteristics respectively), and professional expectations are outlined. MSKVC has already become a pivotal element of musculoskeletal care, due to COVID-19, and these changes are confidently here to stay. Readiness to adapt and evolve will be required of individual musculoskeletal clinical teams as well as organizations, as established paradigms evolve. Cite this article: Bone Joint Open 2020;1-6:272–280.
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Affiliation(s)
- Dominic King
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ahmed K. Emara
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mitchell K. Ng
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Peter J. Evans
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kelly Estes
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kurt P. Spindler
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Thomas Mroz
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brendan M. Patterson
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Viktor E. Krebs
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Stephen Pinney
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nicolas S. Piuzzi
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jonathan L. Schaffer
- Orthopaedic Informatics Working Group, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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