Virtual outpatient assessment in microtia reconstruction: A sustainable and equitable model for quaternary care.

BACKGROUND: Centralisation of highly specialised services improves outcomes for complex congenital conditions, but it often requires families to travel substantial distances for outpatient review and multidisciplinary assessment. Microtia reconstruction in the United Kingdom is delivered through a small number of specialist centres, creating potential financial, logistical and environmental burdens for patients. We evaluated the impact of a fully virtual supra-regional microtia clinic at Great Ormond Street Hospital (GOSH). METHODS: A retrospective review was undertaken of all patients who attended the GOSH virtual microtia clinic between 1 June and 30 November 2025. Appointment type and home postcode data were extracted from electronic health records. Geographic modelling was used to estimate travel distance and journey time to GOSH. Government transport datasets informed calculations of travel costs and carbon emissions according to regional vehicle usage. Northern Ireland journeys were modelled using combined road and air travel. Descriptive statistics were used for analysis. RESULTS: Over six months, 282 patients were reviewed across 25 half-day clinics, with a mean of 11.56 patients per clinic and 70.3% were follow-up appointments. Patients were geographically dispersed across England and Northern Ireland. Virtual consultations avoided an estimated 34,092.68 miles of travel and hours of journey time. Median travel distance for English patients was 33.2 miles (IQR 67.1 miles), with 22% living more than 100 miles from GOSH. Total estimated patient travel cost savings were £9937.50 (£6124.29-13,751.53). Estimated carbon emissions avoided were a minimum of 7304.12 kgCO2e (7433.10 kgCO2e with expected delays and idle time) for England alone and an estimated 10,365 (9711-11,020) kgCO2e including Northern Ireland. CONCLUSIONS: A fully virtual national microtia clinic provides efficient specialist access while substantially reducing travel burden, patient costs and environmental impact. Therefore, telemedicine offers a sustainable and equitable model for delivering highly specialised paediatric reconstructive services.