An Innovative Assessment Framework for Remote Care in Orthopedics

Abstract

Background/Objectives: Orthopedics is a medical specialty that is experiencing a significant increase in the volume of interventions due to an ageing population. By activating remote care pathways, orthopedic surgeons can contribute to improving environmental sustainability. The aim of this research is to develop assessment tools for remote care pathways in orthopedic surgery, inspired by advanced practices of international hospitals. Methods: The research methods consisted in identifying the key areas that make up the remote care pathways in orthopedic surgery and designing appropriate indicators to assess their sustainability. Their levels of achievement were designed by collecting from the literature the most advanced practices reported by hospitals worldwide. The practical validation of the developed model was performed at an orthopedic hospital. Results: Based on the recommendation of the College of Surgeons, we have identified four key areas: remote consultations in orthopedics, incentives for staff travel options, involvement of surgical patients, and minor surgical interventions. In each of these areas, we have designed an indicator, for which we have described the levels of achievement on a scale from 1 to 5. The indicators are also rated for their importance on a scale of 1 to 5, according to the extent to which they influence the achievement of the sustainability objectives. The practical implementation of the developed model at an orthopedic hospital has shown its suitability for the purpose of the research and its compatibility with the certifications held by the hospital. We computed the sustainability indicator in each area as the product between the achievement level and the importance of the indicator. The sum of the four indicators provides the global sustainability indicator. The fulfillment degree of the requirements related to remote care pathways in orthopedic surgery is obtained by reporting the actual value of the global sustainability indicator to the maximum value, which in the explored situation is 61.42%. To have high efficiency for improvement measures we have used the Eisenhower matrix. It is evidenced that the highest priority must be given to the indicator incentives for staff travel options. Conclusions: Implementation of the system in healthcare facilities promotes continuous improvement of remote care pathways in orthopedic surgery, improves environmental sustainability, and thereby contributes to reducing climate change.

Keywords: environment; hospital; indicator; orthopedic surgery; remote care; sustainability.

Figure 1

The PRISMA flow diagram details the systematic review for search and study selection process.

Figure 2

The assessment framework model for remote care pathways in orthopedic surgery.

Figure 3

Achievement level of indicators for the remote care pathways in orthopedic surgery.

Figure 4

The remote care pathways in orthopedic surgery evaluation graph.

Figure 5

The prioritization framework for remote care pathways in orthopedic surgery: (I1) remote consultations in orthopedics, (I2) incentives for staff travel options, (I3) involvement of surgical patients, (I4) minor surgical interventions.