Freeing-Up Outpatients

““Virtual clinics from a patient’s perspective are really useful and easy to use… It means I don’t have to traipse all the way up to hospital, wait in a waiting room just to say yes I’m doing fine and for my consultant to say “oh, that’s great” and then traipse all the way home again.

It’s just online – done, dusted, finished. He gets on with his work and I get on with mine!”

”
— - Mrs Kilty, 72, hip replacement patient at Royal Cornwall Hospital

With over 7 million people on the NHS waiting list the pressure on outpatients clinics has never been greater. Remote digital Patient Reported Outcome Measures (PROMs) can be a valuable tool in addressing the NHS workforce challenge and freeing up busy outpatients.

Rather than relying on intermittent appointments, patients can complete tailored quality of life assessments from the comfort of their homes while doctors and nurses monitor progress remotely. Doing so means they can focus their time and expertise on those patients who require immediate attention to plan resource utilisation such that more patients get more tailored care while the overall need for in-person appointments is reduced. This alleviates the strain on outpatient services, optimises workforce utilisation, and ensures that patients receive timely and appropriate care.

MCO and Freeing-Up Outpatients

Virtual Orthopaedic Follow-up Clinics

MCO was introduced by the orthopaedics team at Royal Cornwall Hospitals NHS Foundation Trust in 2014 as a way of supporting long-term, safe, cost-effective follow-up of hip and knee replacement patients.

The Trust undertakes around 1,200 hip and knee replacements every year with patients travelling from across the whole of Cornwall to be seen.

British Orthopaedic Association guidelines at the time recommended that patients were ideally followed up at 1, 7, 10 and 13 years after joint replacement surgery. At these appointments, a surgeon would check X-ray films and assess reported pain and function. But with most patients reporting no problems, for the majority a costly and time-consuming trip across the county and face-to-face consultation was unnecessary, although for a minority these follow-up assessments were important to identify issues that required attention.

Under the ‘virtual clinic’ follow-up model introduced with My Clinical Outcomes in 2014 and still running in 2023, patients opt to have X-rays done at a community clinic local to them and complete hip and knee PROMs assessments at home on MCO. The X-ray films and scores are then remotely assessed by a surgeon in a virtual clinic, and they can then report back to the patient and their GP.

For the Trust, having patients in the virtual clinic system saves time for consultants – five virtual clinic appointments take the time of two face-to-face appointments – as well as freeing up this capacity for other patients to be seen.

Further Context

A review by researchers from the Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research at the University of Birmingham and published in the Journal of the Royal Society of Medicine in February 2023 looked at international examples of the use of digital PROMs (referred to as electronic patient-reported outcome or ePRO systems in the review) to triage clinical care.

The review looked at benefits across several clinical specialties which included:

  • Facilitation of the triaging of patients.

  • Providing symptom support to clinically stable patients who did not require an outpatient appointment.

  • Helping patients who needed to be seen in person to get an appointment and be seen more quickly.

  • Significant reductions in outpatient appointments.

  • Timely provision of interventions.

  • The administration of ePRO before clinic appointments and the discussion of ePRO results with patients during their appointment fostered a better understanding and documentation of patient symptoms, timely initiation of interventions and enhanced patient–clinician interactions. 

Overall, remote digital PROMs have the potential to enhance patient care, improve efficiency, and address the NHS workforce challenge by freeing up outpatient services and enabling healthcare providers to focus on high-priority cases while still monitoring and supporting patients remotely.

““The use of ePROs in outpatient care could potentially allow a more responsive healthcare system, reduce demand for clinic appointments, reduce time to care with associated improved outcomes, and enhance cost-effectiveness of healthcare delivery – all of which are beneficial to patients, their families and society.”

”
— Prof. Mel Calvert, Director of the Centre for Patient Reported Outcomes (PROs) Research at the University of Birmingham

Get in touch if you would like to know more about how MCO can help reduce pressure on your outpatient clinics or support the introduction of Patient-Initiated Follow-Up (PIFU).

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