Transformation from a traditional model to a virtual model of care in orthopaedic surgery: COVID-19 experience and beyond.

Virtual encounters have experienced an exponential rise amid the current COVID-19 crisis. This abrupt change, seen in response to unprecedented medical and environmental challenges, has been forced upon the orthopaedic community. However, such changes to adopting virtual care and technology were already in the evolution forecast, albeit in an unpredictable timetable impeded by regulatory and financial barriers. This adoption is not meant to replace, but rather augment established, traditional models of care while ensuring patient/provider safety, especially during the pandemic. While our department, like those of other institutions, has performed virtual care for several years, it represented a small fraction of daily care. The pandemic required an accelerated and comprehensive approach to the new reality. Contemporary literature has already shown equivalent safety and patient satisfaction, as well as superior efficiency and reduced expenses with musculoskeletal virtual care (MSKVC) versus traditional models. Nevertheless, current literature detailing operational models of MSKVC is scarce. The current review describes our pre-pandemic MSKVC model and the shift to a MSKVC pandemic workflow that enumerates the conceptual workflow organization (patient triage, from timely care provision based on symptom acuity/severity to a continuum that includes future follow-up). Furthermore, specific setup requirements (both resource/personnel requirements such as hardware, software, and network connectivity requirements, and patient/provider characteristics respectively), and professional expectations are outlined. MSKVC has already become a pivotal element of musculoskeletal care, due to COVID-19, and these changes are confidently here to stay. Readiness to adapt and evolve will be required of individual musculoskeletal clinical teams as well as organizations, as established paradigms evolve. Cite this article:

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ICMJE COI statement: P. J. Evans reports being a paid presenter/speaker from Acumed, a board or committee member for the American Association for Hand Surgery and the American Society for Surgery of the Hand, a paid consultant and presenter/speaker from Axogen, IP royalties and being a paid presenter/speaker from Biomet, and IP royalties from Extremity Medical, Hely Weber and Innomed, stock/stock options from Lineage Medical, Nutek and Tenex, all of which are unrelated to this article. V. E. Krebs reports being on the editorial or governing body of the Journal of Arthroplasty, IP royalties and being a paid presenter/speaker for Stryker, and being a paid consultant for Stryker Orthopaedics, all of which are unrelated to this article. T. Mroz reports being a board or committee member for the Cervical Spine Research Society and the North American Spine Society, being on the editorial or governing board for SpineLine (Editor) and Global Spine Journal (Deputy Editor), having stock/stock options in PearlDiver, and IP royalties from Stryker, all of which are unrelated to this article. B. M. Patterson reports being a board or committee member of the Orthopaedics Trauma Association, which is unrelated to this article. S. Pinney reports being a board or committee member of the Codman Group, on the editorial and governing board of Foot and Ankle International, Foot and Ankle Orthoapedics, the Journal of Bone and Joint Surgery (American), and Techniques in Foot and Ankle Surgery, publishing royalties, financial or material support from FootEducation, and stock/stock options in LifeCycle Health, all of which are unrelated to this article. N. S. Piuzzi reports being a board or committee member of ISCT and the Orthopaedic Research Society, on the editorial or governing board of the Journal of Hip Surgery and the Journal of Knee Surgery, and research support from RegenLab and Zimmer, all of which are unrelated to this article. J. L. Schaffer reports being a paid consultant for MyDoc and Orthogenics, a paid consultant and stock/stock options from Compliant Innovations, stock/stock options from iBalance Medical and SnappSkin, and publishing royalties, financial or material support from Elsevier, all of which are unrelated to this article. K. P. Spindler reports being a board or committee member for AAOS and the American Orthopaedic Society for Sports Medicine, a paid consultant for Cytori-Scientific Advisory Board, Flexion and Mitek, and research support from DJ Orthopaedics and National Institutes of Health (NIAMS and NICHD), all of which are unrelated to this article.