THE EFFECTS OF IMPLEMENTING A VIRTUAL KNEE CLINIC TO STREAMLINE ELECTIVE SERVICES

Introduction 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 work from Glasgow, a new screening tool was implemented to review referrals. Methods and Materials Referrals had to meet the criteria of BMI under 40, recent radiographs and appropriate clinical details including significant past medical history. Consultants 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 15.5% of these being returned. Post protocol there were 2110 patients referred with 30.2% 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 recent evidence suggests could benefit from optimisation of analgesia and physiotherapy in the first instance. Discussion This screening process allows more appropriate referrals to be seen in clinic providing less frustration to clinicians and patients by reducing therapeutic inertia. It allows advice to be given to GPs on further management for the patient. 338 appointments were saved at a cost of £120 per appointment, leading to a real terms cost saving of £40,560.