How Effective Are Telephone and Video Consultations in Shoulder and Elbow Clinics? Analysis Using an Objective Scoring Tool

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic resulted in disruptions of clinical services, which saw more clinics being conducted as telephone and videos. The study aimed to assess and compare the effectiveness of consultations, that is, telephone, video, and face-to-face (F2F) in a shoulder and elbow clinic. Methods: A total of 84 clinic letters from a shoulder and elbow clinic at a district general hospital were analysed using the Ashford Clinic Letter Scoring System. Of these, 30 were F2F, 30 were telephone, and 24 were video consultations. The letters were analysed and scored based on four parameters, that is, whether a working diagnosis was formulated, relevant investigations were requested or available, a clear management plan was formulated, and whether the consultation was deemed valuable by both the clinician and patient. Results: The mean score (out of a total possible of eight) for F2F was 7.967, 7.667 for video, and 7.333 for telephone consultations. Amongst new referrals, F2F performed the best, followed by video with telephone consultations scoring the lowest. With follow-up referrals, the performance of telephone and video consultations was similar but more inferior compared to F2F. Videos performed nearly as well as F2F when it came to formulating treatment plans for patients. Conclusion: F2F consultations remain the gold standard in a shoulder and elbow clinic; however, careful stratification of patients into video, telephone, and F2F clinics can help in optimal delivery of care. These findings can be applied to other surgical specialties and medicine in general. Virtual clinics are viable and potentially cost-effective options to the traditional F2F.

A rapid review of the effectiveness of remote consultations versus face-to-face consultations in secondary care surgical outpatient settings

“…In two studies, reasons for decision against telemedicine was mentioned, which excluded patients who were complex, high-risk, or needed emergency surgery (Lightsey et al 2021, Greven et al 2022). For five of the included studies, no details on eligibility for telemedicine was reported (Crawford et al 2021, Natale et al 2022, Raad et al 2021, Sibanda et al 2021, Ye et al 2022).…”

“…It was reported that there were no differences in overall scores between those who had their initial or follow-up appointments (data combined) by video conferencing compared to in-person (IPC: 7.967; TMC: 7.667; p>0.05) (Sibanda et al 2021). However, across the two studies conducted with different participants through different timeframes there were conflicting results with Sibanda et al (2021) reporting that patients seen via telephone consultations during COVID scored significantly lower than those seen in-person during COVID (IPC: 7.967; TeC: 7.333; p<0.05). Whereas Raad et al (2021) reported that patients seen via telephone consultations during COVID scored significantly higher than those seen in-person pre-COVID (IPC: 6.7; TeC: 7.275; p<0.001).…”

“…In three studies, one cohort was used (Choi et al 2022, Crawford et al 2021, Lightsey et al 2021), and the patients’ initial telemedicine consultation was compared to a second in-person consultation. In seven studies, two cohort groups (telemedicine and in-person) were compared (Aldawoodi et al 2021, Natale et al 2022, Raad et al 2021, Ye et al 2022, Lightsey et al 2021, Uppal et al 2022, Greven et al 2022, Henry et al 2022) and in one additional study, three cohorts were compared (Sibanda et al 2021). Comparison groups either contained participants who were chosen from a sample receiving in-person consultation during COVID or pre COVID historical patient pools.…”

“…. However, across the two studies conducted with different participants through different timeframes there were conflicting results withSibanda et al (2021) reporting that patients seen via telephone consultations during COVID scored significantly lower than those seen in-…”

Orthopedic Telemedicine Outpatient Practice Diagnoses Set during the First COVID-19 Pandemic Lockdown—Individual Observation

“…Teleconsultation remains frequent despite less stringent compliance with mask use and social distancing laws [4,59]. The increase in the use of telemedicine included both voice [88][89][90][91], multimedia [66,[92][93][94][95][96], video consultations [34,63,74,97] as well as videoconferences [13,[98][99][100][101][102][103][104][105]. Videoconferences ensure better patient identification and confirmation of the patient's identity without additional difficulties [106,107].…”