Safe and rapid implementation of telemedicine fracture clinics: the impact of the COVID‐19 pandemic

Abstract

Background: The coronavirus disease outbreak in December 2019 rapidly spread around the world with profound effects on healthcare systems. In March 2020, all elective surgery and elective outpatient clinics were cancelled in our institution, a regional hospital in Northern New South Wales, Australia. With regard to orthopaedic fracture clinics, a telehealth system was implemented on an emergency basis for patient and staff safety to prevent disease transmission. The aim of our study was to investigate whether rapid implementation of telehealth for orthopaedic fracture clinics resulted in an increase in complications. Methods: A retrospective cohort study of all patients with orthopaedic fracture clinic appointments at a regional New South Wales hospital between 17 March and 8 May 2020 was undertaken. There were 191 patients, including 390 appointments of which 23.1% were conducted via telehealth, namely by phone call. Complications requiring phone calls to the orthopaedic team, presentations to the emergency department, admission to hospital or return to theatre, were recorded. Results: There was no increase in complications following emergent implementation of telehealth for orthopaedic fracture clinic follow-up in our institution. Patients in the telehealth group were significantly older than those in the clinic group. Conclusion: The study demonstrates that application of telehealth fracture clinics in a regional Australian setting can be achieved without increasing complication rates and can be used to formulate a rapid telehealth implementation plan if a similar scenario occurs in the future.

Utilization of telehealth by surgeons during the COVID 19 pandemic in Australia: lessons learnt

“…This survey also highlighted that the need for clinical examination varies between subspecialities and between clinical conditions. It is probable that in some clinical situations, the examination could be performed remotely to a satisfactory level, but this will need to be adapted to the individual clinical context 17 . Further evidence is required to establish the safety of remote clinical examination in surgery.…”

Telemedicine in an Outpatient Arthroplasty Setting During the COVID-19 Pandemic: Early Lessons from New York City

“…Although telemedicine practices have existed for decades, with modern telemedicine consultation practices emerging as early as the 1970s to improve rural health care [6], the COVID-19 pandemic rapidly accelerated the adoption and expansion of telemedicine in orthopedics and other specialties [8,16]. Several orthopedic groups have recently described their early experiences with telemedicine programs during the COVID-19 pandemic [7][8][9]11,21]. Of note, most of these reported orthopedic providers' perceptions of telemedicine, while few [7,19,21] reported patients' perspectives.…”

“…Several orthopedic groups have recently described their early experiences with telemedicine programs during the COVID-19 pandemic [7][8][9]11,21]. Of note, most of these reported orthopedic providers' perceptions of telemedicine, while few [7,19,21] reported patients' perspectives. In a study of a postoperative upper extremity telemedicine program during the pandemic, Grandizio et al [7] found that telemedicine resulted in high levels of patient satisfaction, decreased visit times, and decreased travel burdens compared with conventional in-person appointments.…”

“…Telemedicine platforms—previously underused in the orthopedic community [16]—have allowed orthopedic providers to continue seeing patients while adhering to social distancing guidelines. Preliminary reports from new or expanded telemedicine practices during the pandemic in fracture clinics [21], outpatient rehabilitation centers [17], upper extremity postoperative clinics [7], and general orthopedic clinics [13,19] have highlighted several advantages of telemedicine, as well as challenges associated with the accelerated adoption of telemedicine platforms. Total joint arthroplasty represents a unique challenge in the context of telemedicine, as patients undergoing total joint arthroplasty are often older, have comorbidities that put them at higher risk of complications related to COVID-19, and may be more reluctant to try telehealth given concerns that it may be too technical and confusing [1,14,23].…”

Increased orthopaedic presentations as a result of COVID‐19‐related social restrictions in a regional setting, despite local and global trends

“…On 25 March, in accordance with New South Wales (NSW) health regulations, there was temporary suspension of all non‐urgent elective surgeries at our regional hospital in Northern NSW, Australia. Outpatient clinics were mandated to use telehealth where possible, and patients were strongly advised to stay home unless absolutely essential to present for medical review 4 . Most of the population worked or studied from home, and only essential services remained open (Table 1).…”