Remote Clinics During Coronavirus Disease 2019: Lessons for a Sustainable Future

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has led to a focus on non-face-to-face (NF2F) orthopedic clinics. In this study, our aim was to establish whether NF2F clinics are sustainable according to the “triple bottom line” framework by taking into account the impact on patients, the planet, and the financial cost. Methodology This retrospective cohort study was carried out at a large district general hospital with 261 patients identified as having undergone face-to-face (F2F) or NF2F orthopedic consultations (April 2020). These patients were contacted by telephone to establish their experience, mode of transport, and preference for future consultations. Data were also collected relating to environmental and financial costs to the patient and the trust. Results The final analysis included 180 (69%) patients: 42% had an F2F consultation and 58% NF2F consultation. There was no significant difference between each group in terms of convenience, ease of communication, subjective patient safety, or overall satisfaction rating (p > 0.05). Overall, 80% of NF2F patients would be happy with virtual consultations in the future. The mean journey distance was 18.6 miles leading to a reduction in total carbon emissions of 563.9 kgCO 2 e (66%), equating to 2,106 miles in a medium-sized car. The hospital visit carbon cost (heating, lighting, and waste generation) was reduced by 3,967 kgCO 2 e (58%). The financial cost (petrol and parking) was also reduced by an average of £8.96 per person. Conclusions NF2F consultations are aligned to the National Health Service’s “Long Term Plan”: (i) delivering high patient satisfaction with equivalent outcomes as F2F consultations; (ii) reducing carbon emissions from transportation and hospital running; and (iii) becoming cheaper.

Environmental sustainability in orthopaedic surgery

“…Three main environmental issues were identified. Nine studies focused on waste management, 18,[39][40][41][42][43][44][45][46][47] three on carbon emissions, [48][49][50] and one on water usage 51 (Table I). The quality assessment of the studies is detailed in Figure 3.…”

“…Three studies investigated the carbon emissions generated by orthopaedic activities (Table VI). [48][49][50] Baxter et al 48 investigated the CO 2 emissions generated by ten frequently used items across three different hand surgery procedures performed by 32 different surgeons. This study reported a range of 7.8 kg to 28.8 kg of CO 2 emissions generated through the use of these items.…”

Patient Satisfaction With Remote Consultations in a Primary Care Setting

“…The questions selected were based on previous papers by Fatehi et al [ 14 ], who assessed patient satisfaction in a remote diabetic clinic, as well as Curtis et al [ 4 ] and Graham et al [ 5 ], who assessed patient satisfaction for remote orthopaedic consultations in a secondary care setting. The questionnaire was then reviewed and adapted by one general practitioner (GP) and three patients for clarity of content and accessibility via mobile phone.…”

“…The implementation of remote consultations in the form of text messages and telephone and video appointments has been ramped up significantly in recent years [1][2][3]. Telehealth has been shown to be a useful alternative to face-to-face appointments and has advantages for patients, health practitioners and the environment [1][2][3][4][5][6]. Today the use of remote consultations is omnipresent across medical specialities, a process greatly accelerated by the coronavirus disease 2019 (COVID-19) pandemic [2,[6][7][8].…”

“…The advantages of telehealth have been documented in previous papers, with much focus on investigating patients and health care professionals' experiences and attitudes in a secondary care setting [4][5]10]. In the primary care setting, much focus has been on investigating health practitioners' attitudes and experiences with remote consultations [6,8,11], with less emphasis on patient´s experience and satisfaction with remote consultations [12][13].…”