Shared Medical Appointments as a New Model Forcarpal Tunnel Surgery Consultation:A Randomized Clinical Trial

I nitial consultation and patient education are essential components of a clinic visit; however, they require a significant portion of time from both surgeon and patient.Effective informed consent provides patients with more realistic expectations, increases cooperation and results in higher satisfaction (1-4).In comparison, poor clinician communication and inadequate understanding of possible risks are common reasons for patients to seek legal action (5).Ideally, the education process allows adequate time for patients to receive ample information, and for their questions to be answered satisfactorily.However a considerable amount of time is required for sufficiently comprehensive informed consent discussions, and generally comes at the expense increased clinic wait times (6).Worse yet, despite education through the traditional consultation model, patients are often unable to recall the specific risks that are discussed with their surgeon (7-9).Shared medical appointments (SMAs, also known as 'group visits' or 'group consultations') provide an alternative format to individual consultation for patient education.This model can increase the length of time patients receive education about their procedure, and they are also able to discuss the procedure with others who are undergoing the same surgery.The additional benefit is that the total time to see the same number of patients is reduced compared with multiple individual appointments, which results in improved clinic flow and increased access for patients (10-13).Despite provider concerns of patients' reluctance and potential privacy issues, patients consistently report high levels of satisfaction and willingness to participate in future AL Wong, J Martin, MJ Wong, M Bezuhly, D Tang.Shared medical appointments as a new model for carpal tunnel surgery consultation: A randomized clinical trial.Plast Surg 2016;24(2):107-112.BAckgrounD: In chronic disease management, shared medical appointments have been shown to improve clinic access, productivity and patient education.However, adoption of this model in surgical consultation is limited, and its effect on surgical patients' satisfaction, comfort and surgical risk recall is unknown.oBJecTive: To determine whether shared medical appointments could be applied to carpal tunnel surgery consultation while being equally effective as individual consultation for risk recall, patient comfort and satisfaction.MeThoDS: A prospective randomized trial involving 80 patients referred for carpal tunnel release consultation, in which patients were assigned to an educational discussion individually or as part of a shared appointment, was conducted.In a blinded fashion, patients were contacted preoperatively to assess their risk recall and postoperatively to rate their overall satisfaction, comfort and satisfaction with the surgeon.reSuLTS: Patient demographics were equal.Surgical risk recall was equivalent between shared and individual consults (2.06±1.15versus 1.64±1.04;P=0.11).More participants in the shared appointments condition remembered the specific risks of infection (61.1% versus 33.3%; P=0.020) and bleeding (30.6% versus 10.3%; P=0.028).There was no difference in overall satisfaction (8.70 versus 8.88; P=0.75), satisfaction with the surgeon (8.05 versus 8.13; P=0.92) or overall comfort (8.80 versus 8.31; P=0.46).DiScuSSion: Shared medical appointments for carpal tunnel surgery consultation were equivalent to individual consultation in terms of surgical risk recall, patient satisfaction and comfort.concLuSion: These results support the use of shared appointments for large-volume, low-variation surgery.

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