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Objectives: Despite clinical and economic advantages, routine utilization of telemedicine remains uncommon. The purpose of this study was to examine potential disparities in access and utilization of telehealth services during the rapid transition to virtual clinic during the coronavirus pandemic. Design: Retrospective chart review. Setting: Outpatient visits (in-person, telephone, virtual—Doxy.me) over a 7-week period at a Level I Trauma Center orthopaedic clinic. Intervention: Virtual visits utilizing the Doxy.me platform. Main Outcome Measures: Accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”). Methods: All outpatient visits (in-person, telephone, virtual) during a 7-week period were tracked. At the end of the 7-week period, the electronic medical record was queried for each of the 641 patients who had a visit during this period for the following variables: gender, ethnicity, race, age, payer source, home zip code. Data were analyzed for both the total number of visits (n = 785) and the total number of unique patients (n = 641). Patients were identified as accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”). Results: Weekly totals demonstrated a rapid increase from 0 to greater than 50% virtual visits by the third week of quarantine with sustained high rates of virtual visits throughout the study period. Hispanic and Black/African American patients were able to access virtual care at similar rates to White/Caucasian patients. Patients of ages 65 to 74 and 75+ accessed virtual care at lower rates than patients ≤64 ( P = .003). No difference was found in rates of virtual care between payer sources. A statistically significant difference was found between patients from different zip codes ( P = .028). Conclusion: A rapid transition to virtual clinic can be performed at a level 1 trauma center, and high rates of virtual visits can be maintained. However, disparities in access exist and need to be addressed.

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Study Design: A retrospective cohort study. Objective: The objective of this study was to assess the utility of routine in-hospital postoperative radiographs for identifying hardware failure following surgical treatment of traumatic thoracolumbar (TL) injuries. Background: Postoperative radiographs following spine surgery are considered standard of care despite a lack of evidence supporting their utility. Previous studies have concluded that postoperative radiographs following lumbar fusion for degenerative conditions have limited clinical value. Materials and Methods: A retrospective chart review was performed on patients who underwent surgical treatment of traumatic TL injuries between December 2006 and October 2015 at a level I trauma center. Before discharge, postoperative upright anteroposterior and lateral radiographs were obtained and reviewed by 1 surgeon and 1 radiologist as per protocol. Patients who subsequently underwent revision surgery during their initial hospital stay were identified. These patients were further analyzed to identify the indications for surgery and determine if the results of the radiographs obtained led to the subsequent revision surgery. Results: A total of 463 patients were identified who underwent surgical treatment following TL trauma. The rate of revision surgery during the initial hospitalization was 1.3% (6/463). Three patients underwent revision surgery due to worsening neurological status. One patient underwent reoperation because of advance imaging obtained for abdominal trauma. Two patients underwent revision surgery due to abnormal findings on postoperative radiographs. The overall sensitivity and specificity of routine postoperative radiographs was 33.3% and 100%, respectively. Conclusions: In the absence of new clinical signs and symptoms, obtaining routine in-hospital postoperative radiographs following surgical treatment of TL injuries provides minimal value. Clinical assessment should help determine if additional imaging is indicated for the patient. Avoiding unnecessary inpatient tests such as routine postoperative radiograph may offer multitude of benefits including lowering patient radiation exposure, reducing health care costs and better allocation of hospital resources. Level of Evidence: Level III.

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Background: The Coronavirus Disease 2019 (COVID-19) pandemic presents a novel challenge to modern healthcare systems and medical training. Resource allocation and risk mitigation has dramatically affected resident training with the subsequent cancellation of elective procedures, 14-day isolation recommendations, and social distancing requirements. To combat the unique challenges to resident education and wellness, academic leaders must develop new strategies to maintain a healthy, competent residency program. Methods: Our institution implemented a revolving 3-Team system. While the “Inpatient-Team” delivered direct care to orthopaedic patients, the “Back-up Team” and “Quarantine-Team” managed the telemedicine virtual clinic and education-wellness strategy, respectively. The education strategy included active learning methods on virtual platforms, junior resident-specific sessions, and subspecialty-interest panels. Research teams were built and rapidly deployed virtually for large scale retrospective studies. For the wellness strategy plan, our prior resident “family” organization (peer support group) was supplemented by friendly interdepartmental competitions and virtual faculty social hours. In order to evaluate the effectiveness of our implemented strategies a blinded survey was completed by the residents affected by the pandemic. Results: Our 3-Team system allowed for the delivery of safe, high-quality patient care while optimizing resident education, research, and wellness. One hundred percent of residents felt they had the tools necessary to protect themselves throughout the pandemic and 94% felt that program leadership cared about their wellness and safety. In terms of our education and wellness strategy plan, the efficient use of technology led to both improved virtual education outside of the hospital and intentional wellness opportunities despite social distancing restrictions. Eighty-eight percent of residents felt the program was able to offer valuable educational opportunities despite the pandemic. Overall, 76% of residents did not feel the COVID-19 pandemic negatively impacted their training or preparedness for their career, however 75% of PGY4’s felt they missed important subspecialty exposure and 50% felt that it negatively impacted their training. Conclusions: The COVID-19 pandemic is unlikely to be the last challenge the medical training community faces. Utilization of virtual platforms for patient care, education, research, and wellness grew out of necessity in this pandemic, yet represents an opportunity for lasting improvement with re-entry.