Virtual phone clinics in orthopaedics: evaluation of clinical application and sustainability

Abstract

AimsAdoption of virtual clinics has been accelerated by the COVID-19 pandemic and they will continue to form an integral part of healthcare delivery. Our objective was to evaluate virtual clinics in orthopaedic practice and determine how to use them effectively and sustainably.MethodsWe surveyed 100 consecutive patients participating in orthopaedic virtual phone clinic (VPC) at an academic hospital to evaluate patient satisfaction against face-to-face (F2F) consultations and obtain suggestions for improving patient experience, and we surveyed 23 clinicians who conducted orthopaedic VPCs in 2020. Data were correlated with clinic outcomes, reason for consultation, diagnosis, patient age and clinician grade. Consultation duration, clinician-associated costs and reimbursement were analysed. Significance was tested using two-tailed Student’s t-test and Fisher’s exact test.ResultsPatient satisfaction (out of 5) for VPC was significantly lower than F2F (4.1 vs 4.5, p=0.0003), and a larger proportion of VPC scored <3 compared with F2F (11% vs 2%). Higher VPC scores were associated with appointments for delivering results and where patients felt clinical examination was not needed. Patients suggested introducing video capability, adhering to appointment time and offering the choice of VPC or F2F. Mean clinician satisfaction scores for VPC were 4.3/5 and suggested indications for VPC included: routine surveillance, communication of results, discussing/consenting for surgery and vulnerable patients. Integrating video, providing private rooms and offering patients time intervals for VPC were recommended. Current National Health Service VPC structures uses greater clinician resources and generates lower reimbursement than F2F consultations, resulting in 11.5% reduction in reimbursement.ConclusionVPC plays a valuable role when clinical evaluation has been performed or considered not necessary. Offering the choice of VPC or F2F, adding video capability and providing a time interval for VPC may reduce resource use and increase satisfaction. We recommend renegotiating VPC tariffs and cost-neutral modifications of clinic structure.

Telemedicine in orthopaedics and trauma surgery during the first year of COVID pandemic: a systematic review

“…Nevertheless, several applications are successful, such as postoperative telerehabilitation after total knee arthroplasty [ 54 ], or post-operative telemedicine encounters following rotator cuff repair [ 30 ]. Especially follow-up appointments are favourable for telemedicine since the patient-physician-connection is already stable and laboratory or surgery results can be discussed virtually as well [ 21 , 51 , 55 ]. In addition, single parameters such as the range of motion can be reliably evaluated by telemedicine in various joints [ 56 – 58 ].…”

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

“…However, telemedicine-oriented patient education may well solve the problem [37,61,62]. Studies conducted for virtual consultations for orthopedics usually focus on new solutions and technologies [59,[63][64][65][66][67][68][69], patient and clinician satisfaction [4,24,26,46,49,[70][71][72][73][74][75][76][77], clinical outcome measures [78][79][80][81][82], and cost analysis of traditional versus teleconsultation [82][83][84][85][86][87].…”

“…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].…”

Examining the Effectiveness of Telephone Clinics: A Review of a Telephone Foot and Ankle Orthopaedic Clinic in a District General Hospital in the United Kingdom

“…Clinicians should be trained on how to conduct teleconsultations and how to alter the line of questioning to draw as much information as possible without the usual aid of tactile examination. Perhaps, video consultation and telecommunication as a short-term alternative will allow for good patient satisfaction and compliance [15,16]. As we progress beyond the scope of concern for COVID-19 and the theoretical need for social distancing decreases, it remains to be seen whether the general public begins to request a return to FTF appointments, sacrificing the logistical benefits of TFU for the warmth of the doctor-patient relationship.…”