EP.TH.893Virtual Clinic follow-up in Laparoscopic Fundoplication Surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Chenchen Ji ◽  
Benjamin Mitchell ◽  
Christine Tan ◽  
Simon Toh
Keyword(s):  
Financial Incentives ◽  
Laparoscopic Fundoplication ◽  
Elective Surgery ◽  
Surgical Care ◽  
Physical Review ◽  
Outpatient Clinics ◽  
Face To Face ◽  
High Satisfaction ◽  
Virtual Clinic

Abstract Aims There are clinical and financial incentives to reduce follow-up NHS clinics after elective surgery. 55% of our laparoscopic anti-reflux procedures are day-cases procedures. To reduce consultant clinic workload and unnecessary face-to-face patient reviews, we introduced a laparoscopic surgical care practitioner (LSCP) based Virtual Clinic. Methods Patients were telephoned on day 1 and 5 to ensure they were managing their diet without significant post-operative symptoms. This was followed by a Virtual Clinic follow-up at 6-8 weeks, using a universal list of questions and template, and an electronic letter with outcomes recorded. 149 patients underwent laparoscopic fundoplication surgery from September 2016 – May 2018. All follow-up clinics, both virtual and face-to-face, were recorded electronically. These were reviewed, data collected and analysed. Results Between September 2016 – May 2018, 149 patients had laparoscopic fundoplication surgery at our trust with the following clinic outcomes: Conclusions Our LSCP Virtual Clinics discharged 50 out of 149 (33%) patients with no need for face-to-face clinic time, and no detriment to patient care. Those requiring further follow-up were patients who had difficulty managing dietary changes, or experiencing symptoms like dysphagia, often needing physical review and further investigations. Furthermore, patients have expressed high satisfaction with this service. Virtual clinic follow-up is safe, patient-friendly, and reduces both clinical and financial load on NHS outpatient clinics.

The 7th French Airborne Forward Surgical Team experience of surgical support to the population of a low-income country: a prospective study on 341 patients with short-term follow-up

2018 ◽  
Vol 164 (6) ◽  
pp. 423-427 ◽  
Author(s):  
Yvain Goudard ◽  
C Butin ◽  
C Carfantan ◽  
G Pauleau ◽  
E Soucanye de Landevoisin ◽  
...  
Keyword(s):  
Low Income ◽  
Elective Surgery ◽  
Surgical Care ◽  
Host Population ◽  
Surgical Team ◽  
Low Income Country ◽  
Operative Outcomes ◽  
Surgical Teams ◽  
A Prospective Study

BackgroundThe 7th Airborne Forward Surgical Team (FST) has deployed to Chad in 2015 and 2016, in support of French military forces. Humanitarian surgical care is known to represent a significant part of the surgical activity in such missions, but to date limited data have been published on the subject.MethodsAll surgical patients from a civilian host population treated by the FST during these missions have been prospectively included. Indications, operative outcomes and postoperative outcomes were evaluated.ResultsDuring this period, the FST operated on 358 patients. Humanitarian surgical care represented 95% of the activity. Most patients (92.7%) were operated for elective surgery. Emergencies and infectious diseases represented, respectively, 7.3% and 9.1% of cases. The mean length of stay (LOS) was three days (2–4), and the median follow-up was 30 days (22–34). Mortality rate was 0.6% and morbidity was 5.6%. Parietal surgery had no significant complication and had shorter LOS (p<0.001). Emergent surgeries were more complicated (p<0.01) and required more reoperations (p<0.05). Surgical infectious cases had longer LOS (p<0.01).ConclusionsHumanitarian surgical care can be provided without compromising the primary mission of the medical forces. Close surveillance and follow-up allowed favourable outcomes with low morbidity and mortality rates. Humanitarian care is responsible for a considerable portion of the workload in such deployed surgical teams. Accounting for humanitarian care is essential in the planning and training for such future medical operations.

scholarly journals 745 Prospective Evaluation of Virtual Consultations in Paediatric Surgery and Urology: Lessons from the Pandemic Times

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Awolaran ◽  
A M Robotin-Pal ◽  
K Douglas ◽  
J Sheth ◽  
V Kalidasan
Keyword(s):  
Telephone Survey ◽  
Patient Survey ◽  
Definitive Diagnosis ◽  
Outpatient Clinics ◽  
Paediatric Surgery ◽  
Prospective Evaluation ◽  
Face To Face ◽  
Satisfaction Rate ◽  
Video Telephone

Abstract Aim Virtual consultation (VC) became the new norm for providing outpatient clinics during the COVID-19 pandemic. This is likely to be adopted in some form going forward. This study prospectively evaluated the effectiveness&safety of VC undertaken at a UK tertiary paediatric surgical centre during the pandemic. Method Data on paediatric surgery/urology outpatient video/telephone consultations between May-June 2020 was prospectively collected. VC episodes were given outcomes (1,2or3) depending how well surgeons were able to make definitive diagnoses/plans. 6months later, findings at later face-to-face visit were retrospectively compared with earlier VC to assess accuracy of decision-making using VC. Telephone survey of patient experience was done. Results 186VC were evaluated. 95 (51%) were paediatric general surgical patients and 91 (49%) urology. 118 (63%) were follow-ups and 68 (37%) new. In 70% of cases, clinicians were able to make definitive diagnosis/plan using VC (outcome1) while 26% could be delayed till face-to-face consultation is safe (outcome2). 7 patients (4%) needed to be brought in urgently (outcome3). Clinicians were significantly more able to make definitive diagnosis/plan in urology and follow-up patients. Of those brought back for scheduled follow-up/surgery, there was 93% correlation between findings at physical consultation compared to the definitive plans made at VC. Patient survey showed 92% overall satisfaction rate. 75% felt VC is comparable to face-to-face/would use VC again. Conclusions This study provides evidence that VC is an effective&safe way to structure paediatric surgical outpatient care and it highlights the patient categories in which VC is most suitable.

scholarly journals VA Video Telehealth and Training Programs During the COVID-19 Response

2021 ◽  
Author(s):  
Rhonda Johnston ◽  
Rita F. Kobb ◽  
Claire Marty ◽  
Padraic McVeigh
Keyword(s):  
Online Survey ◽  
Surgical Care ◽  
Office Visits ◽  
Face To Face ◽  
Patient Interaction ◽  
Telemedicine Consultation ◽  
Physician Patient ◽  
And Training

Study Design: An online survey modeled after the TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) were administered to gauge patient experience with electronic medical record-based telemedicine visits. Results: Participants noted several advantages of telemedicine visits over traditional in-office visits: shorter visits, saving money, and avoiding potential exposure during the pandemic. Thirty-six percent of the patients agreed that the quality of care was hindered by the lack of a physical exam, and 61.7% of the patients agreed that they prefer a face-to-face visit rather than telemedicine consultation. Most patients were satisfied with the care they received via telemedicine (Likert 6.19/7), and 95.8% of the patients would use telemedicine again. Participants self-reported an average saving of $108.70 when using telemedicine. When comparing the telemedicine cohort to the in-office control, the telemedicine patients noted an improved ability to communicate with their physician in 5 out of 8 domains of the MCCS. Conclusion: Surgical preoperative consultation, postoperative follow-up, and routine visits were conducted via telemedicine during the COVID-19 pandemic, representing a new direction for surgical appointments and consultations. This study shows that telehealth provides satisfactory care and increases access to surgical care for patients when external factors prevent the traditional physician–patient interaction. With better-perceived communication via telemedicine appointments, patients may subjectively feel that they can express their symptoms and gather information from the doctor regarding their diagnosis more efficiently.

Virtual clinic follow-up of hip and knee joint replacement patients

2019 ◽  
Vol 25 (9) ◽  
pp. 270-274
Author(s):  
Timothy J Batten ◽  
Gabriel Fieraru ◽  
Helen Williams ◽  
Jenny Wingham ◽  
Iain Findlay ◽  
...  
Keyword(s):  
Knee Joint ◽  
Joint Replacement ◽  
Patient Reported Outcome Measures ◽  
National Guidelines ◽  
Potential Productivity ◽  
Knee Joint Replacement ◽  
Face To Face ◽  
Patient Reported ◽  
Virtual Clinic

The Royal Cornwall Hospital virtual clinic service was implemented to follow up hip and knee joint replacement patients in line with national guidelines. In total, 300 patients were followed up via a virtual clinic during the first 11 months, and another 520 patients, who were already undergoing conventional face-to-face follow-up, were recruited to the new service for future follow up after consenting and registering with a web-based system for collecting patient reported outcome measures. There were high levels of patient satisfaction: patients found it effective, quick and easy. However, they missed the personal interaction, which occurs during face-to-face appointments. Only 21% of slots were filled and use of the service varied by surgical teams from 6–54%. Further improvements are planned to fulfil a potential productivity gain that converts two face-to-face appointments into five virtual clinic appointments. Following implementation, our local Clinical Commissioning Group awarded a Commissioning for Quality and Innovation grant of £216 000 to sustain the service beyond its first year.

scholarly journals A prospective clinical, cost and environmental analysis of a clinician-led virtual urology clinic

2019 ◽  
Vol 101 (1) ◽  
pp. 30-34 ◽  
Author(s):  
S Miah ◽  
C Dunford ◽  
M Edison ◽  
D Eldred-Evans ◽  
C Gan ◽  
...  
Keyword(s):  
Carbon Footprint ◽  
Cost Savings ◽  
Environmental Benefits ◽  
Face To Face ◽  
Enterprise Value ◽  
Working Age ◽  
Mode Of Transport ◽  
Urology Clinic ◽  
Virtual Clinic

Introduction A virtual clinic is a form of telemedicine where contact between clinical teams and patients occur without face-to-face consultation. Our study aims to quantify the clinical, financial and environmental benefits of our virtual urology clinic. Material and methods We collected data prospectively from our weekly follow-up virtual clinic over a continuous four-month period between July and September 2017. Results In total, we reviewed 409 patients. Following virtual clinic consultation, 68.5% of our patients were discharged from further follow-up. The majority of our patients (male 57.7%, female 55.5%) were of working age. The satisfaction scores were high, at 90.1%, and there were no reported adverse events as a result of using the virtual clinic. Our calculated cost savings were £18,744, with a predicted 12-month cost saving of £56,232. The creation of additional face-to-face clinic capacity has created an estimated 12-month increase in tariff generation for our unit of £72,072. In total, 4623 travel miles were avoided by patients using the virtual clinic, with an estimated avoided carbon footprint of 0.35–1.45 metric tonnes of CO2e, depending on mode of transport. Our predicted 12-month avoided carbon footprint is 1.04–4.04 metric tonnes of CO2e. Conclusions Our virtual clinic model has demonstrated a trifecta of positive outcomes, namely, clinical, financial and environmental benefits. The environmental importance and benefits of a virtual clinic should be promoted as a social enterprise value when engaging stakeholders in setting up such a urological service. We propose the adoption of our virtual clinic model in those urological units considering this method of telemedicine.

scholarly journals Virtual consultations: delivering outpatient clinics in paediatric surgery during the COVID-19 pandemic

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
A. M. Charnell ◽  
E. Hannon ◽  
D. Burke ◽  
M. R. Iredale ◽  
J. R. Sutcliffe
Keyword(s):  
Strong Support ◽  
Service Evaluation ◽  
Outpatient Clinics ◽  
Paediatric Surgery ◽  
Surgical Team ◽  
Information Sheet ◽  
Face To Face ◽  
Surgical Trainees ◽  
The Uk

Abstract Background The COVID-19 pandemic has resulted in many changes to clinical practice, including the introduction of remote clinics. Those familiar with remote clinics have reported benefits to their use, such as patient satisfaction and cost benefits; however, ongoing challenges exist, including delivering optimal patient-centred care. As a tertiary paediatric surgery unit in the UK, completing remote clinics was a new experience for most of our surgical team. We completed a service evaluation early into the COVID-19 pandemic aiming to define and address issues when delivering remote clinics in paediatric surgery. Remote clinics were observed (telephone and video), with follow-up calls to families following the consultations. Results Eight paediatric surgeons were observed during their remote clinics (telephone n = 6, video n = 2). Surgeons new to remote clinics felt their consultations took longer and were reluctant to discharge patients. The calls did not always occur at the appointed time, causing some upset by parents. Prescription provision and outpatient investigations led to some uncertainty within the surgical team. Families (n = 11) were called following their child’s appointment to determine how our remote clinics could be optimised. The parents all liked remote clinics, either as an intermediate until a face-to-face consultation or for continued care if appropriate. Our findings, combined by discussions with relevant managers and departments, led to the introduction of recommendations for the surgical team. An information sheet was introduced for the families attending remote clinics, which encouraged them to take notes before and during their consultations. Conclusions There must be strong support from management and appropriate departments for successful integration of remote clinics. Surgical trainees and their training should be considered when implementing remote clinics. Our learning from the pandemic may support those considering integrating remote clinics in the future.

scholarly journals Is Virtual Clinic the Way Forward: Patient Satisfaction Comparing Phone Clinic vs. Conventional Clinic

2021 ◽  
Author(s):  
Benjamin Wall ◽  
Patrick Daly ◽  
Aidan Dunnill ◽  
Jessica Osan ◽  
Kit Brogan
Keyword(s):  
Patient Satisfaction ◽  
Elective Surgery ◽  
Vital Role ◽  
Face To Face ◽  
Orthopaedic Care ◽  
High Satisfaction ◽  
Patient Questionnaires ◽  
Surgical Conditions ◽  
Mean Time

Abstract Background:Outpatient clinics play a vital role in assessing and treating patients. They traditionally involve face-to-face consultation with a clinician to diagnose and treat many medical and surgical conditions. During the COVID-19 pandemic many of these traditional methods were replaced with telemedicine to minimise patient interaction and therefore potential exposure. This study utilises data from patient questionnaires with the aim of determining patient satisfaction in regard to telemedicine.Method:A list of patients who attended the Rockingham General hospital outpatient Orthopaedic phone clinic was obtained between 23rd of March and 30th of May, this list was then filtered into a randomised generator to provide a call list of patients. Patients were contacted and verbal consent was obtained to participate in satisfaction questionnaire that was completed via phone.Results: A total of 100 patients completed the questionnaire - 50 from elective surgery clinics and 50 from fracture clinics. The mean time for participants’ one-way commute to the hospital was 21 minutes (2 to 60 minutes). Only 4% of telehealth consultations resulted in patients being forced to miss work or school. 13% of patients were required to attend the hospital on the day of their consultation for either radiological imaging or for application or removal of casts or splint. We observed consistently high satisfaction scores across all parameters, in both elective and fracture clinics, culminating in a mean score of 9.08/10 on the Likert scale. In the qualitative component of the questionnaire, patients frequently acknowledged a high quality of care despite adverse circumstances.Conclusion:Telemedicine continues to develop and become a more widely accessible tool in the provision of outpatient orthopaedic care. With its ever-increasing availability and acceptance, it should play a more central role in delivering effective and efficient healthcare to all patients.

scholarly journals 983 Patient’s Satisfaction of Virtual Clinics for Post-Cardiothoracic Surgery Follow Up During COVID

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Durand-Hill ◽  
D Ikenna Ike ◽  
A n Bhardwaj Shah ◽  
Aditi Nijhawan ◽  
Alex Smith ◽  
...  
Keyword(s):  
Service Provision ◽  
Cardiothoracic Surgery ◽  
Outpatient Clinics ◽  
Junior Doctors ◽  
Telephone Consultation ◽  
Patient’S Satisfaction ◽  
Face To Face ◽  
Clinic Appointment ◽  
Patient Reported

Abstract Introduction With advances in technology, virtual clinics are becoming increasingly attractive as a tool for outpatient follow up care. During the COVID-19 pandemic, the implementation of virtual outpatient clinics was crucial, for continued service provision despite social distancing guidelines. We aimed to ascertain patient satisfaction with virtual clinics in cardiothoracic surgery. Method Forty patients who attended virtual clinics, post cardiothoracic surgery, were invited to provide feedback by means of a questionnaire. Feedback was gathered by junior doctors. Results Thirty-four patients (20 had never had a telephone clinic appointment) agreed to provide feedback. Fifty percent of patients had not been seen since their operation. 91.2% (n = 31) of patients felt that the telephone consultation met their expectations/needs. Patient reported advantages of telephone consultations included: less concern regarding exposure to infection, no concern regarding parking, no travel time and less time off work. 79.4% (n = 27) would have preferred a face-to-face appointment. Patient reported disadvantages of telephone consultations were poor reception, felt they weren’t listened to and would have preferred to have been physically examined. Conclusions Patients were satisfied with telephone clinics for routine follow up post cardiothoracic surgery. However, the majority would have preferred face to face appointments.

scholarly journals Telemedicine use in orthopaedics: Experience during the COVID-19 pandemic

2021 ◽  
pp. 1357633X2110410
Author(s):  
Brian Z Chin ◽  
Nazrul Nashi ◽  
Shuxun Lin ◽  
Kevin Yik ◽  
Gamaliel Tan ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Healthcare Delivery ◽  
Outpatient Setting ◽  
Face To Face ◽  
Roles And Responsibilities ◽  
Orthopaedic Patients ◽  
High Satisfaction ◽  
Single Centre Experience ◽  
Satisfaction Rates

Introduction With a recent resurgence of the 2019 coronavirus disease (COVID-19) cases globally, an increasing number of healthcare systems are adopting telemedicine as an alternative method of healthcare delivery in a bid to decrease disease transmission. Continued care of orthopaedic patients in the outpatient setting during the coronavirus disease of 2019 era can prove challenging without a systematic workflow, adequate logistics, and careful patient selection for teleconsultation. The aim of this paper is to describe our single-centre experience with the application of telemedicine in our orthopaedic practice, and its effectiveness in maintaining outpatient follow-up of orthopaedic patients. Methodology We describe our centre's telemedicine model of care for orthopaedic patients on the outpatient follow-up – which includes workforce assembly, population health and target patients, logistics and communications, and overall workflow – with roles and responsibilities of involved people portrayed in detail. Results Feedback from both patients and orthopaedic surgeons reflected high satisfaction rates with care provided, noting minimal communication and clinical barriers compared to face-to-face consultations. Whilst not without limitations, our protocol allowed for rapid adoption of telemedicine in line with a national-wide initiative to digitize healthcare. Discussion The implementation of teleconsultation services at our orthopaedic centre has provided an effective method of healthcare delivery while enforcing social distancing measures – which proves vital in combating the spread of COVID-19 and ushering in a new normal.

scholarly journals Is virtual clinic follow-up of hip and knee joint replacement acceptable to patients and clinicians? A sequential mixed methods evaluation

2019 ◽  
Vol 8 (1) ◽  
pp. e000502 ◽  
Author(s):  
Rebekah J Parkes ◽  
Joanne Palmer ◽  
Jennifer Wingham ◽  
Dan H Williams
Keyword(s):  
Knee Joint ◽  
Joint Replacement ◽  
District General Hospital ◽  
Free Text ◽  
Structured Interviews ◽  
Knee Joint Replacement ◽  
Face To Face ◽  
Patient Reported ◽  
Virtual Clinic

ObjectiveTo evaluate the acceptability to key stake holders of a newly introduced virtual clinic follow-up pathway for hip and knee joint replacement.DesignA service evaluation comprising a questionnaire sent electronically to 115 patients and interviews with 10 individuals.SettingA newly introduced virtual clinic follow-up pathway for hip and knee replacement patients in a district general hospital.ParticipantsThe electronic questionnaire was distributed to all patients treated under the virtual clinic service over a 5-month period (n=115). Purposive sampling from volunteers among respondents, leading to semi-structured interviews with eight patients. Two orthopaedic consultants were also interviewed.InterventionConsultant review of web-based patient reported outcome measures and digital radiographs, with feedback to patients via letter, replacing face-to-face outpatient appointments for the follow-up of hip and knee joint replacement.ResultsThe response rate to the questionnaire was 40%. 44% indicated they would prefer a virtual appointment over a face-to-face consultation in future. The most common word in the free text comments was ‘good’ (n=107).Seven main themes were identified from the patient interviews: patient understanding and expectations, patient confidence, patient voice, managing deterioration of condition, patient benefit, patient satisfaction using technology and navigating the website.Two main themes were identified from the staff interviews: the adapting patient pathway and project management.Combined analysis elucidated that patients who were doing well liked the ‘click and go’ approach but those with problems were concerned about how to report these and were therefore less satisfied.ConclusionThe virtual clinic process appears to be well accepted by both patients and clinicians. However, appropriate patient selection and clear pathways of communication to address patient concerns are pivotal to success.

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