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  • Led by the Royal Cornwall Hospitals Trust, in partnership with Kernow Clinical Commissioning Group.
  • Introduced a virtual clinic for follow up of the trust’s hip and knee replacement patients.
  • Aimed to improve the efficiency of the follow up of these patients, without compromising quality and patient acceptability.
  • Designed and implemented a virtual clinic service that uses online patient reported outcomes and digital x-ray reports from community x-ray facilities.

The orthopaedic team at the Royal Cornwall Hospitals Trust has looked at whether new technology can help reduce the burden on the NHS and improve follow-up experience for hip and knee replacement patients.

Hip and knee joint replacement operations are increasingly being performed, with over 160,000 patients having replacements in the UK in 2014. National guidelines recommend follow up of each patient at one, seven and every subsequent three years following surgery. These follow-ups are traditionally carried out face-to-face.

The virtual follow-up service introduced at the Royal Cornwall Hospitals Trust looked to improve efficiency and reduce costs. The project involved using the existing network of community clinics with x-ray facilities and online patient reported outcome measures (PROMs). The clinical team could view electronic x-ray films and PROMs and so track the patient’s progress.

Since its introduction in October 2014, 300 patients have been followed up in the virtual clinic and another 520 patients have chosen the new service for future follow up. Patient satisfaction has been high. Patient surveys suggest that the virtual clinic follow-up service is thought to be equivalent to face-to-face services, with patients generally finding it effective, quick and easy, although some miss the personal interaction. All respondents reported having an x-ray at a location of their choice, and many said they saved money and/or time. The Commissioning for Quality and Innovation (CQUIN) scheme has agreed to support the service in the future.

Timely engagement of patients was a challenge for the project team, and required more administrative input than expected. Another challenge was achieving buy-in from all surgical teams, which had an impact on the number of patients being seen at virtual clinics, and getting agreement to apply a standard approach to patient follow up.

Contact details

For further information about the project, please email Dan Williams at Royal Cornwall Hospital Trust.

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