Leeds Institute of Rheumatic and Musculoskeletal Medicine, UK.
University of Leeds, UK.
Ann R Coll Surg Engl. 2023 Mar;105(3):252-262. doi: 10.1308/rcsann.2021.0356. Epub 2022 Aug 17.
Over 200,000 hip and knee total joint arthroplasties (TJAs) are performed annually in England and Wales. UK guidelines recommend regular follow-up because missed early failure can result in complex revision surgery, which places additional burden on overstretched orthopaedic services. This study evaluated the feasibility and acceptability of an expert, consensus-based, standardised virtual clinic (VC) approach for TJA follow-up.
Five UK secondary care orthopaedic centres implemented a standardised VC. Feedback was obtained through patient satisfaction questionnaires and telephone interviews with arthroplasty care practitioners. Key stakeholders subsequently attended an expert discussion forum to achieve consensus on the final VC format and to address obstacles identified during testing.
From 19 June 2018 to 11 December 2018, 561 TJA patients [mean age (SD) 70 (9.4) years, 57.8% female, 69.0% hip TJA, 1-28 years postsurgery (median 5 years)] completed a VC. Of these 561 patients, 82.2% were discharged without attending an outpatient appointment and 46 (8.8%) required early face-to-face consultant review. Patient satisfaction with the VC was high (156/188; 83.0%); over 70% of patients indicated a preference for the VC.
This feasibility study suggested significant resource savings, including time spent by consultant orthopaedic surgeons in outpatient clinics, hospital transport and an estimated saving of up to two-thirds of usual clinic-allotted time. The expert discussion forum provided helpful feedback for supporting more efficient implementation of the VC.
A standardised VC is a feasible alternative to outpatient clinics for the follow-up of hip and knee TJA patients, and is acceptable to key stakeholders, including patients.
在英国和威尔士，每年有超过 20 万例髋关节和膝关节全关节置换术（TJA）。英国指南建议定期随访，因为早期漏诊的失败可能导致复杂的翻修手术，这会给已经过度紧张的骨科服务带来额外的负担。本研究评估了一种基于专家共识的标准化虚拟诊所（VC）TJA 随访方法的可行性和可接受性。
5 家英国二级保健骨科中心实施了标准化 VC。通过患者满意度问卷和与关节置换护理医生的电话访谈获得反馈。随后，主要利益相关者参加了一个专家讨论论坛，就最终 VC 格式达成共识，并解决测试中发现的障碍。
从 2018 年 6 月 19 日至 2018 年 12 月 11 日，561 例 TJA 患者[平均年龄（SD）70（9.4）岁，57.8%为女性，69.0%为髋关节 TJA，术后 1-28 年（中位数 5 年）]完成了 VC。在这 561 例患者中，82.2%无需就诊即可出院，46 例（8.8%）需要早期进行面对面的顾问复查。患者对 VC 的满意度很高（156/188；83.0%）；超过 70%的患者表示更喜欢 VC。
这项可行性研究表明，这一方法具有显著的资源节约效果，包括减少了顾问骨科医生在门诊的时间、医院交通和节省了三分之二以上的常规诊所分配时间。专家讨论论坛为支持 VC 的更有效实施提供了有益的反馈。
标准化 VC 是髋关节和膝关节 TJA 患者门诊随访的一种可行替代方案，并且得到了包括患者在内的主要利益相关者的认可。
