scholarly journals P41 Development of a Montgomery compliant consent discussion aide memoire leading to the establishment of a 'remote consent clinic'

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Elena Priestman ◽  
Joseph Anderson ◽  
Alex Curtis ◽  
Andrew Kelly ◽  
Elena Priestman

Abstract In response to the Montgomery ruling and increasing costs due to improper consenting, specialties such as spinal surgery have implemented consent clinics performed between the conventional initial consultation and day of surgery. However, as this new process can be cost and labour intensive, providing the clinic remotely has been proposed as a way of streamlining this service. This review aims to develop a Montgomery-compliant checklist that provides practical considerations on conducting a remote consent clinic, with scope to integrate this initially into orthopaedic practice. Two literature searches were conducted with the first establishing previous study in remote consent clinics and the second determining the feasibility and financial viability of providing a remote clinic against a face-to-face clinic. The initial analysis revealed remote consent clinics as a relatively novel area of research. However, both literature searches suggested improvements in both patient recall and understanding in remote consenting, further enhanced by additional resources. Moreover, remote clinics are more efficient and cost-effective while still maintaining high patient satisfaction; outcomes are further improved by delegating this service to alternative staff members. Patients also benefit from the complete erasure of travel times and associated costs. Additionally, in the era of COVID-19, it limits patient exposure allowing hospitals to provide safer services. Consent clinics, when performed remotely, are a cost-effective and efficient tool to minimise negligence claims while maximising patient satisfaction. In line with the digitisation of healthcare, it also allows for a COVID-appropriate service. Nevertheless, to ease the transition, a practical checklist has been developed.

2021 ◽  
Vol 27 (1) ◽  
pp. 26-31
Author(s):  
Sonia Bouri ◽  
Jean-Frédéric LeBlanc ◽  
Ravi Misra ◽  
Nikolaos Kamperidis ◽  
Gabriela Poufou ◽  
...  

Background/Aims During the COVID-19 pandemic, inflammatory bowel disease clinics were converted to telephone clinics at St. Mark's Hospital in Harrow. This study assessed the response of patients and clinicians to remote telemedicine services, with the view of establishing whether there was scope for increasing the role of remote services in the inflammatory bowel disease clinics. Methods Clinicians administered a questionnaire to patients at the end of their appointments regarding their opinions on the telephone clinic format. Eleven questions used a 5-point Likert scale while a further three questions asked the patient for their comments on future clinics. Clinicians provided information about the patients' condition and management, as well as their own comments. Results Overall satisfaction with telephone clinics was found to be high among patients and clinicans, with many feeling that telephone clinics were more convenient. In total, 94.3% of patients said they would prefer either all telephone or a mix of phone and face-to-face clinics in the future. However, some patients felt that it was more complicated to have blood or stool tests done and roughly a quarter of patients were concerned that something could be missed without a physical examination. Conclusions High patient satisfaction can be achieved by delivering a mix of telephone, video and face-to-face clinics. In certain clinical situations, face-to-face clinics would be appropriate, such as patients with active diseases and first appointments. The pandemic is an opportunity respond to patients' preferences by increasing the range of remote care options.


2019 ◽  
Vol 101 (7) ◽  
pp. 519-521
Author(s):  
MS Athar ◽  
MA Fazal ◽  
N Ashwood ◽  
G Arealis ◽  
D Buchanan ◽  
...  

Introduction Daycase trauma surgery is an evolving and a novel approach. The aim of our study was to report our experience of daycase trauma surgery with a focus on safety, patient experience, complications and limitations. Material and methods Patients scheduled and operated on a daycase trauma list from January 2013 to December 2016 were included in the study. Age, sex, case mix, readmissions within 48 hours, complications, patient satisfaction, reasons for overnight stay and cost effectiveness were evaluated. Results A total of 229 procedures were carried out. The mean age of the patients was 44.3 years (range 16–85 years) . There were 128 men and 101 women, 178 upper-limb and 51 lower-limb cases. Only 2.6% of the patients had stayed overnight for pain control, physiotherapy and neurological observations; 94.5% of the patients were satisfied. The mean visual analogue scale score for satisfaction was 8.7. There were no admissions within 48 hours of discharge and one complication with failure of ankle fixation. The estimated cost saving was £65,562. Conclusion We conclude that a daycase trauma service is safe, cost effective, and yields high patient satisfaction. It reduces the burden on hospital beds and a wide range of upper- and lower-limb cases can be performed as daycase trauma surgery with adequate planning and teamwork.


Author(s):  
John Wickman ◽  
Colleen Ferlotti ◽  
Justin Ferrell ◽  
Carolyn Hutyra ◽  
Donna Phinney ◽  
...  

Abstract Telehealth videoconferencing has been shown to be feasible, cost-effective and safe in numerous fields of medicine. In an effort to increase access and improve the quality of care offered to patients we implemented a telehealth initiative allowing for remote orthopedic clinic visits at a major academic medical center. Here we report on our experience and early outcomes. A telehealth platform was launched for a single fellowship trained orthopedic surgeon at a major academic hospital in August 2018. New patients residing outside the metro area, all return patients and patients with an uncomplicated post-operative course were offered the option to complete patient encounters remotely via a telehealth platform. Each patient was offered a Patient Satisfaction Survey following video visit. Patient zip codes were used to estimate patient commutes. Ninety-six percent of patients agreed/strongly agreed with the statement ‘I was satisfied with my Telehealth experience’ while 51% agreed/strongly agreed with the statement ‘This visit was just as good as a face to face visit’. In all, 94% of patients agreed/strongly agreed with the statement ‘Having a telehealth visit made receiving care more accessible for me’. The median miles saved on commutes were 123.3 miles. The no show rate for telehealth visits was 8.2% versus 3.2% for in-person (P < 0.001). Telehealth video visits provided patients with a modality for completing orthopedic clinic visits while maintaining a high-quality care and patient satisfaction. Patient convenience was optimized with video visits with elimination of long commutes. Level of evidence: IV.


2020 ◽  
Vol 18 (9) ◽  
pp. 22-27
Author(s):  
Michelle Brooks ◽  
Audrey Cund

Background Remote clinics, where patients attend appointments over telephone or video calls, are increasingly replacing traditional in-person consultations. In the UK, gastroenterology clinics have generally occurred in hospital outpatient departments, and uptake of remote clinics had been slow, before accelerating in the COVID-19 pandemic. Aims This literature review aimed to assess the use, advantages and disadvantages of remote clinics in adult and paediatric gastroenterology. Methods A literature search was carried out for articles in English published since 2000. Findings Four articles were identified, two on adult and two on paediatric gastroenterology services. Benefits highlighted included high patient satisfaction with and preference for remote clinics, owing to reduced travel time and cost. Services reported reduced nonattendance rates compared with in-person clinics. Authors and patients cautioned that remote clinics should not entirely replace face-to-face contact, which has advantages for visual assessment and building clinician–patient relationships. Conclusions Remote clinics are effective for gastroenterology services. Further research is recommended to capture the qualitative experience of the patients, families and nurses involved in these remote clinics.


2020 ◽  
Vol 14 (1) ◽  
pp. 198-203
Author(s):  
Ihsan Mahmood ◽  
Robert Burton ◽  
Muhammad N. Choudhry ◽  
Christopher Coapes

Background: Trapezio-Metacarpal Joint (TMJ) arthritis is a common cause of radial sided wrist pain. After conservative measures have been exhausted, the current mainstay of surgical treatment is trapeziectomy. Some surgeons combine this with additional ligament reconstruction and tendon or capsular interposition techniques to provide a more stable base for the thumb metacarpal. Purpose: In modern Orthopaedic practice, arthroplasty is the procedure of choice for many end-stage arthritic joints. However, due to the reliable and reproducible outcomes of trapeziectomy, this has yet to be widely adopted by hand surgeons in the management of TMJ arthritis. Recent series of arthroplasty implants have consistently shown good outcomes and trapezio-metacarpal joint replacement has been observed to provide excellent long-term function in the fit and active patient. Methods: We have performed a total of 52 TMJ arthroplasties in 46 patients in our institution for over 5 years (2011 to 2016). After excluding 3 cases, 43 available patients (49 implants) were subsequently asked to submit QuickDASH scores and a patient satisfaction survey. Results: Average QuickDASH score was 16.6, with high patient satisfaction postoperatively at 1 year. Complications included one intraoperative fracture, and five cases of post-operative instability/ dislocation. Dislocations were treated successfully with open reduction and revision. Conclusion: TMJ arthroplasty has shown good outcomes and patient satisfaction with a low revision rate and we recommend its use in active patients with well-preserved scapho-trapezio-trapezoid (STT) joints.


2009 ◽  
Vol 91 (4) ◽  
pp. 301-304 ◽  
Author(s):  
MJ Reid ◽  
LA David ◽  
JE Nicholl

INTRODUCTION By December 2008, 90% of referrals requiring hospital admission will need to be seen and treated within the 18-week patient pathway. Previously, patients within our trust with suspected carpal tunnel syndrome had to wait 3 months to see a specialist in clinic and, once assessed, would have to wait up to a further 6 months for an open carpal tunnel decompression under local anaesthetic (OCTD/LA). We set up a one-stop clinic, where patients would have their out-patient consultation and surgery on the same day. We evaluated the clinic in order to assess whether it led to reduced waiting times whilst maintaining good clinical outcome and patient satisfaction. PATIENTS AND METHODS Patients were selected on the basis of the standard referral letter alone. Those selected were then assessed by a single surgeon in the clinic. The patients deemed appropriate underwent an OCTD/LA and were discharged the same day. Patients were followed up with a patient satisfaction and Boston questionnaire. RESULTS Forty-six patients underwent 63 OCTD/LA, waiting an average of 2.2 months (9 weeks) from referral. There was high patient satisfaction and improvement in symptoms following treatment in the clinic. CONCLUSIONS We believe a one-stop carpal tunnel clinic can be an efficient and cost-effective way of treating this common condition.


2014 ◽  
Vol 4 (1) ◽  
pp. 23-29
Author(s):  
Constance Hilory Tomberlin

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.


1985 ◽  
Vol 24 (03) ◽  
pp. 163-165 ◽  
Author(s):  
K. John

SummaryAs many bibliographic services in medicine are offered, literature searches in eight databases at DIMDI were performed to find out which database is most important in medicine. The distribution of publications from members of the medical faculty of Frankfurt University was examined. No save prediction is possible as to which database will yield most articles. Overlapping from different databases is often rather low. The selection of an appropriate database mix for sufficient recall and in a cost-effective manner.is a task for an experienced searcher.


2003 ◽  
Vol 1 (2) ◽  
pp. 208-222 ◽  
Author(s):  
Georgia N. L. Johnston

Working with faith communities in health promotion is widely acclaimed and yet not readily practiced. This article describes a study conducted among four faith communities to determine the process required for sustainable faith-based programs. Face-to-face interviews were conducted among 12 community volunteers who participated to identify their perceptions of the project. Two staff members were also interviewed to identify the process from their perspectives. Project-related documents were also analyzed to provide details and triangulate the data from the interviews. The study followed the project for 2 ½ years. Several factors were identified as significant influences on participation and project sustainability. These included value, active pastoral support, program success, and volunteer commitment. The results of this study indicate that pastoral support and faith community ownership are critical components that should be included in faith-based community building efforts.


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