A HYBRID VIRTUAL BABY HIP CLINIC IMPROVES CARE FOR THE NONOPERATIVE TREATMENT OF DEVELOPMENTAL DYSPLASIA OF THE HIP IN INFANTS

Recent literature has demonstrated that standardized protocols and more limited use of ultrasound can be safely implemented with excellent outcomes in the nonoperative management of developmental dysplasia of the hip (DDH) in infants. Implementation of remote care management across healthcare services is increasingly affording reduced travel and costs to caregivers, with high rates of satisfaction. There was consensus among our clinician team that hybrid in-person and virtual care in clinic would provide numerous improvements in family-centred care. Therefore, we established a new hybrid virtual model of care in our Baby Hip Clinic for DDH. This quality improvement study implemented a Plan-Do-Study-Act iterative model. This study occurred in a unified multidisciplinary Baby Hip Clinic between December 2022 and October 2023. Practice changes were made to a published comprehensive nonoperative DDH treatment protocol by switching to virtual interim follow-up visits for consultation and examination, and omitting ultrasound examination once the hip was centred as per evidence-based guidelines. New online educational resources for caregivers were added to supplement reduced in-person care. A dedicated clinic email was created for streamlined asynchronous clinical advice from healthcare providers. Caregiver and staff satisfaction surveys were administered to collect feedback on satisfaction, clinic flow and perceived quality of care. Fifty-two infants and their caregivers, and 20 staff were enrolled in the study. Forty-nine infants successfully completed the brace treatment. Three infants failed brace treatment, and two developed femoral nerve palsy, which resolved, and both successfully completed brace treatment. No failures of brace treatment or complications occurred during the virtual follow-up care period. Seventy-seven virtual follow-up visits occurred in place of in-person visits. Travel to the clinic was reduced by 6,220 km for caregivers. Seventy-seven fewer ultrasound scans were ordered, saving $15,500 in imaging costs, compared to previous standardized protocol. The institutional DDH educational website drew over 12,000 views during the 11-month study period, and the new Baby Hip Clinic email received over 38 emails requesting advice on DDH and brace care. 265 caregiver satisfaction surveys and 45 staff satisfaction surveys were completed. 93% of caregivers were either satisfied or very satisfied with virtual visits, and 85.1% of staff rated satisfaction with virtual appointments as either good or excellent. This study successfully streamlined care to minimize in-person visits, made use of the hospital's new virtual care platforms, reduced the need for expensive, scarce imaging resources, and improved caregiver experience while maintaining exceptional clinical results. Our hybrid virtual Baby Hip Clinic represents an advance in the model of care for nonoperative management for DDH which could increase equitable access, especially for those in remote and economically challenged areas.