Clinical decision making in the provision of audiovisual care for upper limb trauma: a survey of UK experiences. (March 2021)

• Record Type: Journal Article
• Authors: McMullen, Emily; Robson, Megan; Brewin, Mark Paul; Valand, Poonam; Sayed, Leela; Steele, Jessica
• Is Part Of: Hand therapy. Volume 26:Number 1(2021)
• Page Start: 17
• Page End: 25
• Publication Date: 2021-03
• Subjects: Telehealth -- audio-visual -- hand injury -- hand therapy -- upper limb trauma -- COVID-19; Hand -- Wounds and injuries -- Treatment -- Great Britain -- Periodicals; Hand -- Wounds and injuries -- Patients -- Rehabilitation -- Great Britain -- Periodicals; 617.57506
• DOI: 10.1177/1758998320972132
• Languages: English
• ISSNs: 1758-9983

Abstract

Introduction: For many patients, audio-visual appointments have provided a timely and efficient way of seeking advice, assessment and treatment for their hand injuries during the NHS response to COVID-19. This study aimed to explore the experience of hand units across the UK in determining the safe and judicious use of audio-visual outpatient care for the management of acute upper limb trauma. Methods: An online cross-sectional survey was sent to the therapy leads of hand units across the UK. Questions focused on the experience of using audio-visual technology in the management of upper limb trauma, and the relevant factors in determining its appropriate use. A deductive mixed methods analysis was used to identify both common themes and capture community experience and characteristics. Results: A total of 51 out of 76 hand therapy units completed the survey; a response rate of 67%. Of these, 82% (42/51) reported using audio-visual technology to manage upper limb trauma during the UK COVID-19 lockdown. When determining patient suitability for audio-visual consultations, 73% (37/51) of respondents reported the use of COVID-19 guidelines, but only 35% (18/51) reported the use of a clinical decision-making tool. In agreement with our experience at Salisbury Hospital Foundation Trust, 92% (47/51) had concerns relating to the use of audio-visual care. Conclusion: The choice of safely managed remote care or in-person consultation has, to date, largely relied on the discretion of the clinician. A carefully designed clinical decision-making tool for the management of upper limb trauma is needed for use both in clinical practice and in future service planning.