Do teleconsultations increase patient access to orthopaedic care?

This study evaluates whether orthopaedic teleconsultations provide timelier access compared to in-person visits.

We prospectively analysed scheduling data (1 July 2022-1 January 2023) for the 15 busiest orthopaedic surgeons (by total teleconsultations) at a Midwest academic healthcare system. Three metrics were assessed using EHR data: (1) third next available clinic day (adjusted for physician visit modality frequency via standardization: $\frac{Thirdnextavailableday}{\left(1-visitmodalityfrequency\right)}$ ), (2) same day availability (proportion of available vs. filled return slots), and (3) lead time (days between scheduling and appointment). These metrics reduce cancellation bias, reflect immediate access, and capture patient-facing delays, respectively. Teleconsultations accounted for 8% of total appointments; standardization addressed volume disparities to isolate modality efficiency.

Appointment data from seven orthopaedic surgeons were analysed for third next available/same day metrics; lead time included data from six surgeons. In-person appointments had a shorter median availability (2 vs. 3 clinic days, p < 0.001), which means at current in-person/teleconsultation frequencies a patient was able to schedule an in-person visit 1 clinic day faster than a teleconsultation. When adjusted for a lower frequency, teleconsultations had better access efficiency (3.53 vs. 46.88, p < 0.001, lower = better access)-they were easier to schedule relative to their availability. Same day availability was higher for teleconsultations (31.15% available vs. 16.2% available, p < 0.001). New teleconsultations had shorter lead times (median 5.0 days vs. 13.0 days, p < 0.01).

When visits were standardized, teleconsultations provide greater access compared to in-person visits relative to their frequency. Additionally, even with the current visit volume (in-person = 92%, teleconsultation = 8%), new patients were able to see providers sooner through teleconsultations. While in-person orthopaedic visits cannot be replaced by virtual visits, particularly in cases of acute pathology, increasing the availability of teleconsultation appointments can enhance access. Appropriate digital infrastructure, training, and workflow are necessary to ensure the appropriate selection of visit modalities.

II (Prospective Cohort).