Objective assessment of the efficacy of telephone medicine consultations in dispensing elective orthopaedic care using a novel scoring tool.

BACKGROUND

Telemedicine consultations have increased significantly as a result of the COVID-19 pandemic. As remote consultations have been employed across specialities, there has been limited analysis of their efficacy. The goal of this study is to objectively assess if telephone medicine is valuable for clinical consultations in elective orthopaedics using a novel scoring tool.

METHODS

A literature review and survey were performed to determine the objectives of a specialist consultation. Based on the results, a four-component scoring system was developed with a set of guidelines. Eighty telephone consultation letters from a hip and knee clinic were scored by two independent observers. The results were compared and the guidelines were clarified. Clinic letters from previous face to face consultations from the same clinic were scored and compared to telephone medicine letters. The inter-observer reliability was calculated using Cronbach's Alpha.

RESULTS

The mean score of the telephone consultations was 7.3 as compared to 7.9 (Maximum possible score-8) with face to face consultations. Second opinion referrals scored the least when consulted over the telephone, while follow-up patients both pre-operative and post-operative scored similar to face to face consultations. The inter observer reliability co-efficient was more than 0.8 for every component of the score suggestive of good reliability.

CONCLUSIONS

This study identifies the areas where telephone medicine can make a valuable contribution to making diagnosis and treating orthopedic patients. We plan to use this to stratify future clinic appointments. The score is a simple, concise and reliable tool whose role may not be limited to orthopaedics but can be extended to other medical fields.