Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany.
BMC Musculoskelet Disord. 2022 Mar 2;23(1):196. doi: 10.1186/s12891-022-05144-9.
In the context of the German contact restrictions due to the COVID-19 pandemic of March 2020, an online-based consultation system was established in our university orthopedic outpatient department to maintain patient care. As a basis for contact-minimizing communication, this was continued after the contact restrictions were lifted. The aim of this prospective pilot study was to assess the effectiveness, technical feasibility, and patient flow in this system under lockdown conditions and in the period afterwards.
The evaluation took place from the beginning of the first lockdown on March 13, 2020, until May 31, 2021. For each patient encounter, the quality of the sound and video connections was documented. The outcomes of the consultations were recorded. Four categories were distinguished: 1) no follow-up necessary, 2) follow-up via online consultation, 3) referral for surgical therapy, and 4) follow-up in the outpatient clinic for physical examination. A comparison was made between an early cohort right after implementation of the online consultation and and a late cohort after establishment of the consultation.
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 necessary. Follow-up via online consultation was scheduled in 82 (20%) patients, direct referral for surgery was made in 86 (21%) patients, and a follow-up for physical examination was arranged in 165 (40%) patients. When comparing the early and late cohort, there was no difference in the duration of the conversation (p = 0.23). A significant difference was found in the type of further treatment. In the late cohort, conservative therapy was used more often (p < 0.01), resulting in a lower number of follow-up visits for clinical examination (p < 0.01).
While a definite decision for further procedure was possible solely by online consultation in a large percentage of cases, 40% of patients still needed an additional in-person consultation for physical examination. A learning curve could be observed regarding the selection of patients suited for online consultation. Overall, online consultation is a useful measure to manage patient volume and to visibly support direct doctor-patient contact.
在 2020 年 3 月德国因 COVID-19 大流行而实施接触限制的背景下，我们大学的骨科门诊建立了一个基于网络的咨询系统，以维持患者的护理。作为减少接触沟通的基础，在接触限制解除后，这种方式仍在继续。本前瞻性试点研究的目的是评估在封锁期间和之后，该系统在有效性、技术可行性和患者流程方面的情况。
评估从 2020 年 3 月 13 日第一次封锁开始，一直持续到 2021 年 5 月 31 日。为每次就诊记录了声音和视频连接的质量。记录了咨询的结果。区分了以下四类：1）无需后续治疗，2）通过在线咨询进行后续治疗，3）转诊接受手术治疗，以及 4）在门诊进行体格检查。将在线咨询实施后的早期队列与建立咨询后的晚期队列进行了比较。
共进行了 408 次在线咨询。共有 360 次（88%）咨询没有中断。初始表现占 124 次（30%）咨询。75 次（18%）患者无需进一步随访。82 次（20%）患者通过在线咨询进行随访，86 次（21%）患者直接转诊接受手术治疗，165 次（40%）患者安排了体格检查。在比较早期和晚期队列时，对话持续时间无差异（p=0.23）。但进一步治疗的类型存在显著差异。在晚期队列中，更多地使用了保守治疗（p<0.01），因此，需要进行临床检查的随访次数减少（p<0.01）。
虽然在很大比例的病例中，仅通过在线咨询就可以做出明确的进一步治疗决策，但仍有 40%的患者需要进行额外的体格检查门诊就诊。在选择适合在线咨询的患者方面，可以观察到学习曲线。总体而言，在线咨询是一种管理患者量和明显支持医患直接联系的有用措施。
