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dc.contributor.authorJabbal, A
dc.contributor.authorCarter, T
dc.contributor.authorBrenkel, I J
dc.contributor.authorWalmsley, P
dc.date.accessioned2024-02-15T12:30:01Z
dc.date.available2024-02-15T12:30:01Z
dc.date.issued2023-12-01
dc.identifier293600640
dc.identifier5ea4e8f6-80e0-49ed-99f0-e034b647f0d6
dc.identifier37640609
dc.identifier85168995528
dc.identifier.citationJabbal , A , Carter , T , Brenkel , I J & Walmsley , P 2023 , ' The virtual knee clinic - A tool to streamline new outpatient referrals ' , Surgeon , vol. 21 , no. 6 , pp. e367-e371 . https://doi.org/10.1016/j.surge.2023.07.005en
dc.identifier.issn1479-666X
dc.identifier.urihttps://hdl.handle.net/10023/29257
dc.description.abstractINTRODUCTION: Traditionally it has been the case for orthopaedic consultants to review GP referrals for the orthopaedic outpatient clinic where possible in amongst other clinical commitments. This could sometimes lead to unsuitable patients being reviewed and both patients and clinicians becoming frustrated. Building on the virtual fracture clinic, a new screening tool was implemented to streamline new referrals. The aim of this study is to investigate the change in patients given outpatient appointments following the introduction of a new streamlining protocol. METHODS: Referrals had to meet the criteria of BMI under 40 or evidence of weight loss effort, recent radiographs and appropriate clinical details in keeping with Getting It Right First Time (GIRFT). Consultant were given dedicated clinical time to review and either triage the patient to the most appropriate clinic type, or return the referral with advice to the GP. 10 months of data was collected prior to the protocol and 10 months after implementation. RESULTS: 1781 patients were referred pre-protocol with an average of 14.2% of these being returned. Post protocol there were 2110 patients referred with 31.2% returned. There was an increase in 195% of referrals returned to the GP (p < 0.0001). The highest proportion of these was for mild to moderate osteoarthritis on the radiograph which has been proven to be unsuitable for intervention. At 12 month analysis there was no significant increase in patients re-referred to the service (p = 0.53)  DISCUSSION: The new screening tool allows more appropriate referrals to be seen in clinic allowing less frustration to clinicians and patients by reducing therapeutic inertia. Furthermore it allows new referrals to be seen by the most appropriate sub-specialist. It allows advice to be given to GPs on further management for the patient. 619 appointments were saved. At a cost of £120 per appointment, this leads to a real terms cost saving of £74,280, with further savings in time and travel.
dc.format.extent5
dc.format.extent158916
dc.language.isoeng
dc.relation.ispartofSurgeonen
dc.subjectVirutal clinicen
dc.subjectTotal knee arthroplastyen
dc.subjectKnee surgeryen
dc.subjectService designen
dc.subjectHealth economicsen
dc.subjectEfficiencyen
dc.subject3rd-NDASen
dc.titleThe virtual knee clinic - A tool to streamline new outpatient referralsen
dc.typeJournal articleen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.identifier.doi10.1016/j.surge.2023.07.005
dc.description.statusPeer revieweden


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