Determining Access of In-Person vs Virtual Clinic Visits in Orthopedic Medicine

INTRODUCTION: Virtual visits in orthopedics provide added benefits compared to in-person visits. We hypothesize that virtual visits will offer patients greater same-day and future access to orthopedic physicians. METHODS: Two previously established methodologies were used to measure orthopedic surgeons: same-day and third-next-available. Same-day access is analyzed using a ratio of unfilled to filled virtual return and in-person return appointments for every clinic day of each physician. Third-next-available is measured as the number of total non-clinic days and clinic days until each physician’s third next-available-virtual and in-person appointments. RESULTS: For same-day access, the ratio of unfilled virtual to filled virtual appointments was 1.04 on average, while the ratio of unfilled in-person to filled return in-person visits was 0.38 on average (p=0.00323). For third-next-available appointments, the in-person opening was 5.81 days out on average compared to the virtual visit being 8.31 days out on average (p=0.01525). Additionally, the in-person appointment was 2.5 clinic-days out on average and the virtual appointment was 3.95 clinic-days out on average (p\u3c0.001). As virtual visits are a fraction of total visits, we divided the third-next-available data by the rate at which each physician books virtual appointments. This resulted in a significantly increased standardized third-next-available measure of access for virtual appointments using both total days (p\u3c0.001) and clinic days (p\u3c0.001). DISCUSSION/CONCLUSION: Virtual return visits offer greater same-day access for patients compared to analogous in-person return visits. However, in-person appointment availability offers better access for patients in terms of scheduling a future visit, which may be due to the increased number of in-person visits offered compared to virtual visits provided at this time. When standardizing the third-next-available data for how often each visit modality is offered, virtual visits displayed greater levels of patient access. Thus, an increased volume of virtual visit appointments may offer patients greater access for scheduling purposes in the future

Development and Validation of a Novel Decision Aid for WALANT Hand Surgeries: Investigating Patient Preferences

INTRODUCTION: This study aims to develop a novel decision aid packet (DAP) for hand surgery patients deciding between Wide-Awake-Local-Anesthesia-No-Tourniquet (WALANT) and traditional anesthesia. METHODS: Development: The DAP was developed following International Patient Decision Aid Standards. Validation: Alpha Testing Seven hand surgeons experienced in WALANT and traditional surgeries belonging to the WALANT Research Consortium in the U.S. commented on the DAP through three rounds of editing utilizing the Delphi method. Seven patient advocates provided readability feedback. Beta Testing Orthopedic hand surgery patients were assigned to the control or experimental group. The experimental group was given the DAP pre-surgery. Both groups completed a validated regret scale at follow-up. A paired t-test was conducted to analyze the difference between average scores on the regret scale and pre- and post-DAP knowledge tests (p RESULTS: The experimental group (n=58) demonstrated a 145% increase (p DISCUSSION: Increased knowledge test scores following the DAP suggest that patients are better informed after DAP usage. Low decisional conflict scores suggest that the DAP increases patients’ confidence. Lower average regret scale scores among the experimental group indicate a relationship between DAP administration and reduced post-surgical regret. The greater patient preference for WALANT following DAP usage, alongside the lower postoperative regret, elucidates a general preference in informed patients towards the WALANT modality