Online outpatient trauma orthopedic surgery consultation: is there a learning curve?

This article was originally published here

BMC musculoskeletal disorder. 2022 Mar 2;23(1):196. doi: 10.1186/s12891-022-05144-9.


BACKGROUND: In the context of the German contact restrictions due to the COVID-19 pandemic of March 2020, an online consultation system has been set up in our university orthopedic outpatient department to maintain patient care. As a basis for contact-minimizing communication, this was continued after contact restrictions were lifted. The objective of this prospective pilot study was to evaluate the efficacy, technical feasibility and patient flow in this system under containment conditions and in the period thereafter.

METHODS: The evaluation took place from the start of the first confinement on March 13, 2020, until May 31, 2021. For each patient encounter, the quality of the sound and video links was documented. The results of the consultations were recorded. Four categories were distinguished: 1) no follow-up necessary, 2) follow-up by online consultation, 3) referral for surgical treatment and 4) follow-up in outpatient clinic for physical examination. A comparison was made between an early cohort just after setting up the online consultation and a late cohort after setting up the consultation.

RESULTS: There were 408 patient encounters via online consultation. A total of 360 (88%) consultations were uninterrupted. Initial presentations accounted for 124 (30%) consultations. In 75 (18%) patients, no further follow-up was required. A follow-up by online consultation was scheduled in 82 (20%) patients, a direct referral to surgery was made in 86 (21%) patients and a follow-up for physical examination was organized in 165 (40%) patients. Comparing the early and late cohort, there was no difference in conversation duration (p = 0.23). A significant difference was found in the type of subsequent treatment. In the late cohort, conservative treatment was used more often (p

CONCLUSION: While a final decision for an additional procedure was only possible by online consultation in a large percentage of cases, 40% of patients still required an additional in-person consultation for a physical examination. A learning curve could be observed regarding the selection of patients suitable for online consultation. Overall, the online consultation is a useful measure to manage the volume of patients and to visibly support the direct doctor-patient contact.

PMID:35236325 | DOI: 10.1186/s12891-022-05144-9