Developing and implementing a virtual clinic for follow-up of major joint arthroplasty in the NHS

Abstract

Introduction: Virtual clinics whereby patient information is collected remotely and then reviewed by specialists in a central location have been used previously in remote areas for ophthalmology services with good acceptability noted for patients. With removal of a face-to-face consultation efficiency for services can improve allowing focus of services where it is most needed. This is critical in orthopaedic services where, in 2014–15 over 7.5million outpatient appointments were scheduled. Methods: We introduced a virtual clinic for all major joint follow-up in our trust with patients sent ‘patient reported outcome measures’ (PROM) and invited to attend for radiology at local centres with results reviewed centrally. We then assessed reply rates and the numbers requiring normal outpatient review to assess the benefit of the virtual clinic service. Results: Over a 10-week trial period, 151 patients were eligible for virtual clinic review. Sixteen (10.6%) did not reply, although 14 of these patients had attended for radiology. Of the 135 who did respond 16 (11.8%) required some form of reminder to return PROMs. Of the 151 patients 19 (13%) subsequently required conventional outpatient review either for poor results on PROM or abnormality identified on radiology. This represents an average 13 saved outpatient appoints per week with an obvious cost saving benefit to our trust.

Effectiveness, Patient Satisfaction, and Cost Reduction of Virtual Joint Replacement Clinic Follow-Up of Hip and Knee Arthroplasty

“…Virtual follow-up clinics have been reported to be cost-effective compared to standard in-person follow-up [ 7 , 12 , 24 ], reducing the number of patients attending regular follow-up clinics, without compromising safe practice [ 20 ]. Kingsbury et al [ 7 ] estimated that an experienced orthopedic surgeon could review a questionnaire and a radiograph in 2 minutes whereas an outpatient appointment can take from 10 to 20 minutes.…”

“…After a successful pilot in our university hospital with encouraging results, we further developed a Virtual Joint Replacement Clinic (VJRC) [ 12 ]. The aim of this study is to investigate the reliability, patient’s satisfaction, and cost-effectiveness of the VJRC.…”

“…Clinic (VJRC) [12]. The aim of this study is to investigate the reliability, patient's satisfaction, and cost-effectiveness of the VJRC.…”

Virtual Clinics: Descriptive Survey of A Sample of Models Used Within Orthopedics in The United Kingdom

“…While the use of VCs in orthopedics has become increasingly popular over the past decade, literature surrounding the topic is scarce. Research has primarily focused on virtual fracture clinics (VFCs) replacing traditional FTF fracture pathways [7-9] with some mention of joint arthroplasty follow-ups being replaced by virtual orthopedic clinics (VOCs) [4,[10][11][12]. King D, et al [13] report that VCs should be considered as one part of the musculoskeletal pathway but that the paradigm for delivery is still evolving.…”

“…Virtual clinics (VCs) are one way of achieving this goal, and have been deemed safe, cost-effective, and associated with high levels of patient satisfaction [3,6-8].While the use of VCs in orthopedics has become increasingly popular over the past decade, literature surrounding the topic is scarce. Research has primarily focused on virtual fracture clinics (VFCs) replacing traditional FTF fracture pathways [7-9] with some mention of joint arthroplasty follow-ups being replaced by virtual orthopedic clinics (VOCs) [4,[10][11][12]. King D, et al [13] report that VCs should be considered as one part of the musculoskeletal pathway but that the paradigm for delivery is still evolving.Although guidelines and protocols provide a framework for professionals to follow and recommendations of how healthcare should be delivered [14], to-date, there are no standards pertaining…”