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Efficacy of physician associate delivered virtual outpatient clinic

Daniel Meehan (Royal College of Surgeons in Ireland, Dublin, Ireland)
Ameera Balhareth (Royal College of Surgeons in Ireland, Dublin, Ireland)
Madhumitha Gnanamoorthy (Department of Anaesthetics, Midland Regional Hospital Mullingar, Mullingar, Ireland)
John Burke (Beaumont Hospital, Dublin, Ireland)
Deborah A. McNamara (Department of Surgery, Beaumont Hospital, Dublin, Ireland)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 12 August 2019




The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources, increasing operational efficiency and considering new processes all have a role in improving delivering these services. The purpose of this paper is to evaluate the safety of a physician associate (PA) delivered virtual outpatient department (VOPD) consultation service that was established in a General and Colorectal Surgery Department at an Irish teaching hospital.


A series of low-risk surgical patients were referred by senior surgeons to a PA delivered virtual clinic (VOPD). Medical records belonging to half the included patients were randomly selected for review by two doctors three months following discharge back to primary care to confirm appropriate standards of care and documentation and to audit any recorded adverse incidents or outcomes.


In total, 191 patients had been reviewed by the PA in the VOPD with 159 discharged directly back to primary care. Among the 95 medical records that were reviewed by the NCHDs, there were no recorded adverse incidents after discharge. Medical record keeping was deficient in 1 out of 95 reviewed cases.

Practical implications

Using a PA delivered VOPD consultation appears to have a role in following up patients who have undergone low-risk procedures irrespective of age or co-morbidity when selected appropriately. This may assist in reducing the demand on outpatient services by reducing unnecessary return visits, thereby increasing the capacity for new referrals.


While there are reported examples to date of virtual clinics, these relate to services delivered by registered medical practitioners. Here, the authors demonstrate the acceptability of this model of care in an Irish population as delivered by a PA.



Conflict of interest: the authors have no conflicts of interest to declare.

Ethical approval was sought from Beaumont Hospital Ethics (Medical Research Committee) and deemed not to be required for this service evaluation. The Beaumont Hospital Quality and Safety Department were notified about the study and it was registered as a clinical audit.


Meehan, D., Balhareth, A., Gnanamoorthy, M., Burke, J. and McNamara, D.A. (2019), "Efficacy of physician associate delivered virtual outpatient clinic", International Journal of Health Care Quality Assurance, Vol. 32 No. 7, pp. 1072-1080.



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