Residents and fellows forum: Impact on general surgery clinic after telehealth conversion at a Veteran Affairs medical center

Abstract: Since the COVID-19 pandemic, there has been a significant increase in telehealth use for patient evaluations. The Veteran Health Administration (VHA) has tripled phone and video visits across several specialties. There are hesitations in phone-call-based communication for procedural subspecialties. However, phone calls to veterans have proven safe and efficacious after general surgery procedures. Telehealth has additional benefits, including reducing transportation barriers, improving access to care, and reducing delays in medical care. We sought to evaluate clinic access after the establishment of routine telehealth use through phone calls by the surgeon. Our hypothesis is that patients who use telehealth will have a lower rate of “no-show” to their appointments. This is an observational cohort study completed at Rocky Mountain Regional VA Medical Center in Aurora, Colorado. General surgery clinic volume was systematically assessed via the Group Practice Managers Performance Metrics application. All general surgery outpatient appointments from January 2019 to December 2021 were included in the evaluation. These appointments consist of new patient evaluations, postoperative follow-ups, and established patient care appointments. A total of 11,607 appointments were scheduled in the general surgery clinic during the study period, of which the majority were in-person, 11,114 (96%) appointments. Before the pandemic (Jan 2019 through Feb 2020), general surgery scheduled 351 ± 43 appointments monthly with 4 ± 1 (1%) via telehealth. Telehealth is of particular importance to the veteran population due to their advanced age, high prevalence of comorbidities, high rates of homelessness, difficulty with transport, and the large geographic area of Veteran Integrated Services Networks. Of the approximately 4.7 million veterans residing in rural communities, 27% do not have Internet access at home, negating the common smartphone application–based telehealth methods.