Telephone versus face-to-face neuro-oncology consultations: comparing patient satisfaction, convenience, family support and clinician attitude during the COVID-19 pandemic

Abstract Aims During the first wave of the COVID-19 pandemic, to limit the number of patients attending hospital, the neuro-oncology department selected a large number of appointments to be conducted via the telephone. This project aimed to determine how patients and clinicians perceived telephone consultations in the neuro-oncology service compared to traditional face to face appointments. Method A 20-question patient satisfaction survey combined quantitative and qualitative questions and was distributed between June and August 2020. These were distributed by email to 88 patients who attended neuro-oncology clinic in person ("face-to-face"), or by telephone. Concurrently, a 15-question survey was distributed to all clinicians conducting telephone and face-to-face consultations for the neuro-oncology service. Questions included in the clinician survey were designed to mirror the patient satisfaction questionnaire where possible. Fisher's exact test was used to determine significance, which was set at p< 0.05. Results 51.1% (n=45) of patients returned the questionnaire. Of those who received telephone appointments, 89.5% (n=17) felt the consultation was convenient, 94.7% (n=18) were satisfied and 80.0% (n=16) were able to have a family member/friend present. Of those who attended face-to-face appointments, 96.0% (n=24) felt their consultation was convenient, 100% (n=25) were satisfied and 87.5% (n=21) were able to have a family member/friend present. There was no significant difference in patient convenience, satisfaction or family/friend presence (p=0.395, p=0.432 and p=0.498 respectively) between face-to-face and telephone clinics. Overall, the clinicians reported undertaking a mean of 9.5 telephone consultations per week. Only 42.8% (n=3) use telephone appointments for first-time neuro-oncology consultations, whereas 100.0% (n=7) use them for results and follow-up appointments. Only 51.7% (n=4) felt that undertaking telephone consultations is convenient and 42.8% (n=3) have experienced difficult situations with patients during telephone consultation. Conclusion This project suggests that neuro-oncology telephone consultations provide patients with the same level of satisfaction and convenience as face-to-face appointments. We have also demonstrated that using the telephone does not provide a significant barrier to having family or friends present to support the patient. We have shown that clinicians are universally utilising neuro-oncology telephone appointments for follow-up and results whereas much fewer use the telephone for performing initial consultations. Given the high-level of satisfaction demonstrated in the patient questionnaires this reflects effective patient-selection for remote consultations. The COVID-19 pandemic has forced oncology services to evolve and results of this project suggest that telephone neuro-oncology consultations are widely accepted by patients and clinicians. We therefore propose that remote consultations should continue beyond the pandemic in select cases.

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Are telephone consultations here to stay in rheumatology?

Rheumatology Advances in Practice ◽

10.1093/rap/rkaa071 ◽

2020 ◽

Author(s):

Sabrina R Raizada ◽

Natasha Cleaton ◽

James Bateman ◽

Diarmuid M Mulherin ◽

Nick Barkham

Keyword(s):

Older Patients ◽

Online Survey ◽

Vulnerable Groups ◽

Age Group ◽

Telephone Consultation ◽

Survey Tool ◽

Face To Face ◽

Vulnerable Patients ◽

Number Of Patients

Abstract Objectives During the COVID-19 pandemic, face-to-face rheumatology follow-up appointments were mostly replaced with telephone or virtual consultations in order to protect vulnerable patients. We aimed to investigate the perspectives of rheumatology patients on the use of telephone consultations compared with the traditional face-to-face consultation. Methods We carried out a retrospective survey of all rheumatology follow-up patients at the Royal Wolverhampton Trust who had received a telephone consultation from a rheumatology consultant during a 4-week period via an online survey tool. Results Surveys were distributed to 1213 patients, of whom 336 (27.7%) responded, and 306 (91.1%) patients completed all components of the survey. Overall, an equal number of patients would prefer telephone clinics or face-to-face consultations for their next routine appointment. When divided by age group, the majority who preferred the telephone clinics were <50 years old [χ2 (d.f. = 3) = 10.075, P = 0.018]. Prevalence of a smartphone was higher among younger patients (<50 years old: 46 of 47, 97.9%) than among older patients (≥50 years old: 209 of 259, 80.7%) [χ2 (d.f. = 3) = 20.919, P < 0.001]. More patients reported that they would prefer a telephone call for urgent advice (168, 54.9%). Conclusion Most patients interviewed were happy with their routine face-to-face appointment being switched to a telephone consultation. Of those interviewed, patients >50 years old were less likely than their younger counterparts to want telephone consultations in place of face-to-face appointments. Most patients in our study would prefer a telephone consultation for urgent advice. We must ensure that older patients and those in vulnerable groups who value in-person contact are not excluded. Telephone clinics in some form are here to stay in rheumatology for the foreseeable future.

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COVD-26. TELEPHONE CONSULTATIONS IN NEURO-ONCOLOGY DURING THE COVID-19 PANDEMIC: LEVELS OF PATIENT SATISFACTION AND COMPARISON WITH TRADITIONAL FACE-TO-FACE CONSULTATIONS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.107 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii26-ii26

Author(s):

Emma Toman ◽

Claire Goddard ◽

Frederick Berki ◽

William Garratt ◽

Teresa Scott ◽

...

Keyword(s):

Patient Satisfaction ◽

University Hospitals ◽

Health Crisis ◽

Patient Satisfaction Questionnaire ◽

Telephone Consultation ◽

Exact Test ◽

Face To Face ◽

Significant Difference ◽

The Face ◽

The University

Abstract INTRODUCTION Controversy exists as to whether telephone clinics are appropriate in neurosurgical-oncology. The COVID-19 pandemic forced neuro-oncology services worldwide to re-design and at the University Hospitals Birmingham UK, telephone clinics were quickly implemented in select patients to limit numbers of patients attending hospital. It was important to determine how these changes were perceived by patients. METHODS A 20-question patient satisfaction questionnaire was distributed to patients who attended neuro-oncology clinic in person (“face-to-face”), or via the telephone. Fisher’s exact test was used to determine significance, which was set at p< 0.05. RESULTS Eighty questionnaires were distributed between June 2020 and August 2020. Overall, 50% (n=40) of patients returned the questionnaire, 50% (n=23) of face-to-face and 50% (n=17) telephone patients. Of those who received telephone consultations, 88% (n=15) felt the consultation was convenient, 88% (n=15) were satisfied with their consultation and 18% (n=3) felt they would have preferred to have a face-to-face appointment. Of those who attended clinic in person, 96% (n=22) felt their consultation was convenient, 100% (n=23) were satisfied with their consultation and 13% (n=3) would have preferred a telephone consultation. Within the face-to-face clinic attendees, only 13% (n=3) were concerned regarding the COVID risk associated with attending hospital. There was no significant difference in patient convenience or satisfaction (p=0.565 and p=0.174 respectively) between face-to-face and telephone clinics. There was no significant difference in whether patients would’ve preferred the alternative method of consultation (p > 0.999). CONCLUSION Our study suggests that careful patient selection for neuro-oncology telephone clinic is not inferior to face-to-face clinic. Telephone clinic during COVID-19 pandemic proved to be convenient, safe and effective. This global health crisis has transformed telephone neuro-oncology consultations from an experimental innovation into established practice and should be continued beyond the pandemic in select cases.

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P071 Survey of rheumatology patient satisfaction with telephone consultations during the COVID-19 pandemic

Rheumatology ◽

10.1093/rheumatology/keab247.069 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Mia Rodziewicz ◽

Terence O'Neill ◽

Audrey Low

Keyword(s):

Patient Satisfaction ◽

Physical Examination ◽

Management Plan ◽

Service Development ◽

Telephone Consultation ◽

Face To Face ◽

Communication Difficulties ◽

Strongly Agree ◽

The Uk

Abstract Background/Aims Rheumatology departments were required to switch rapidly from face-to-face (F2F) to remote consultations during the COVID-19 pandemic in the UK. We conducted a patient satisfaction survey on the switch to inform future service development. Methods All patients [new (NP), follow-up (FU)] were identified between 1st to 5th June 2020. Patients who attended or did not attend (DNA) a pre-booked F2F consultation or cancelled were excluded. Of the remainder, half the patients was surveyed by phone using a standardised questionnaire and the other half was posted the same questionnaire. Both groups were offered the opportunity to complete the survey online. Patients were surveyed on the organisation and content of the consultation, whether they were offered a subsequent F2F appointment and future consultation preference. Results 233 consultations were scheduled during the study period. After 53 exclusions (34 pre-booked F2F, 16 DNA, 3 cancellations), 180 eligible consultations were surveyed (85 via mailshot, 95 by telephone). 75/180 patients (42%) responded within 1 month of the telephone consultation (20 NP, 47 FU, 8 missing). The organisation of the switch was positively perceived (Table). Patients were highly satisfied with 4 of the 5 consultation domains but were undecided whether a physical assessment would have changed the outcome of the consultation (Table). After the initial phone consultation, 7 of 20 NP and 19 of 47 FU were not offered subsequent F2F appointments at the clinicians’ discretion. Of those not offered subsequent F2F appointments, proportionally more NP (3/7, 43%) would have liked one, compared to FU (5/19, 26%). Reasons included communication difficulties and a desire for a definitive diagnosis. 48/75 (64%) would be happy for future routine FU to be conducted by phone “most of the time" or "always”; citing patient convenience and disease stability. Caveats were if physical examination was required or if more serious issues (as perceived by the patient) needed F2F discussion. Conclusion Patients were generally satisfied with telephone consultations and most were happy to be reviewed again this way. NPs should be offered F2F appointments for first visits to maximise patient satisfaction and time efficiency. P071 Table 1:Median age, yearsFemale; n (%)Follow-up; n (%)All eligible for survey; n = 18056122 (68)133 (74)Sent mailshot; n = 855459 (69)65 (76)Surveyed by phone; n = 955663 (66)68 (72)Responder by mail; n = 166911 (69)13 (82)Responder by phone; n = 525437 (71)34 (65)Responder by e-survey; n = 7495 (71)UnknownOrganisation of the telephone consultation, N = 75Yes, n (%)No, n (%)Missing, n (%)Were you informed beforehand about the phone consultation?63 (84)11 (15)1 (1)Were you called within 1-2 hours of the appointed date and time?66 (88)6 (8)3 (4)Domains of the consultation, N = 75Strongly disagree, n (%)Disagree, n (%)Neutral, n (%)Agree, n (%)Strongly agree, n (%)Missing, n (%)During the call, I felt the clinician understood my problem3 (4)1 (1)1 (1)20 (27)49 (65)1 (1)During the call, I had the opportunity to ask questions regarding my clinical care1 (1)02 (3)16 (21)55 (73)1 (1)A physical examination would have changed the outcome of the consultation16 (21)18 (24)20 (27)11 (15)10 (13)0The clinician answered my questions to my satisfaction2 (3)06 (8)18 (24)49 (65)0At the end of the consultation, the clinician agreed a management plan with me3 (4)2 (3)6 (8)24 (32)39 (52)1 (1)Future consultations, N = 75Never, n (%)Sometimes, n (%)Most of the time, n (%)Always, n (%)Missing, n, (%)In the future, would you be happy for routine FU to be conducted by phone?5 (7)20 (27)16 (21)32 (43)2 (3) Disclosure M. Rodziewicz: None. T. O'Neill: None. A. Low: None.

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Remote Consultations Versus Standard Face-to-Face Appointments for Liver Transplant Patients in Routine Hospital Care: Feasibility Randomized Controlled Trial of myVideoClinic

Journal of Medical Internet Research ◽

10.2196/19232 ◽

2021 ◽

Vol 23 (9) ◽

pp. e19232

Author(s):

Sarah Damery ◽

Janet Jones ◽

Elaine O'Connell Francischetto ◽

Kate Jolly ◽

Richard Lilford ◽

...

Keyword(s):

Patient Satisfaction ◽

Liver Transplant ◽

Usual Care ◽

Real Time ◽

Process Evaluation ◽

Face To Face ◽

Transplant Patients ◽

Qualitative Process Evaluation ◽

Remote Consultations

Background Using technology to reduce the pressure on the National Health Service (NHS) in England and Wales is a key government target, and the NHS Long-Term Plan outlines a strategy for digitally enabled outpatient care to become mainstream by 2024. In 2020, the COVID-19 response saw the widespread introduction of remote consultations for patient follow-up, regardless of individual preferences. Despite this rapid change, there may be enduring barriers to the effective implementation of remote appointments into routine practice once the unique drivers for change during the COVID-19 pandemic no longer apply, to which pre-COVID implementation studies can offer important insights. Objective This study aims to evaluate the feasibility of using real-time remote consultations between patients and secondary care physicians for routine patient follow-up at a large hospital in the United Kingdom and to assess whether patient satisfaction differs between intervention and usual care patients. Methods Clinically stable liver transplant patients were randomized to real-time remote consultations in which their hospital physician used secure videoconferencing software (intervention) or standard face-to-face appointments (usual care). Participants were asked to complete postappointment questionnaires over 12 months. Data were analyzed on an intention-to-treat basis. The primary outcome was the difference in scores between baseline and study end by patient group for the three domains of patient satisfaction (assessed using the Visit-Specific Satisfaction Instrument). An embedded qualitative process evaluation used interviews to assess patient and staff experiences. Results Of the 54 patients who were randomized, 29 (54%) received remote consultations, and 25 (46%) received usual care (recruitment rate: 54/203, 26.6%). The crossover between study arms was high (13/29, 45%). A total of 129 appointments were completed, with 63.6% (82/129) of the questionnaires being returned. Patient satisfaction at 12 months increased in both the intervention (25 points) and usual care (14 points) groups. The within-group analysis showed that the increases were significant for both intervention (P<.001) and usual care (P=.02) patients; however, the between-group difference was not significant after controlling for baseline scores (P=.10). The qualitative process evaluation showed that—according to patients—remote consultations saved time and money, were less burdensome, and caused fewer negative impacts on health. Technical problems with the software were common, and only 17% (5/29) of patients received all appointments over video. Both consultants and patients saw remote consultations as positive and beneficial. Conclusions Using technology to conduct routine follow-up appointments remotely may ease some of the resource and infrastructure challenges faced by the UK NHS and free up clinic space for patients who must be seen face-to-face. Our findings regarding the advantages and challenges of using remote consultations for routine follow-ups of liver transplant patients have important implications for service organization and delivery in the postpandemic NHS. Trial Registration ISRCTN Registry 14093266; https://www.isrctn.com/ISRCTN14093266 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-018-2953-4

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P066 Telephone clinics: what are our patients saying?

Rheumatology ◽

10.1093/rheumatology/keab247.063 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Muhammad Azhar Abdullah ◽

Nicholas Heng ◽

Sajjad Noor ◽

Urooj Ahmed ◽

Clare Lavery ◽

...

Keyword(s):

Patient Satisfaction ◽

Action Plan ◽

Phone Call ◽

Telephone Consultation ◽

Face To Face ◽

Video Consultation ◽

Patient Groups ◽

To Receive ◽

Good Patient Satisfaction

Abstract Background/Aims Telemedicine has not previously been a regular part of routine rheumatology services.Our department adopted telephone clinics during the COVID-19 pandemic. We assessed patient satisfaction by conducting a feedback survey. Our aim was to obtain a patient perspective on remote consultations and on preferred future follow up options including video or face-to-face consultations. Methods The cohort included 160 rheumatology patients who had a telephone consultation between May and mid-June 2020. All patients consented to receive a further phone call by a different member of the team. Patients had to answer a questionnaire about recent consultation and to rate this on a scale of 1-5. Other questions included whether all their queries were answered; clear action plan made; perceived benefits or disadvantages of telephone consultation; and views about future follow up and any additional comments. Results 71.9% of 160 patients were females while 28.1 % males. Mean age 58.6 yrs. More than half of the patients (60.6%) had a diagnosis of inflammatory arthritis, followed by connective tissue disease (19.3%), other diagnosis (8.1% ) & vasculitis (5.6%). 94.4 % of the patients in this study were return appointments-the remainder new. Feedback results revealed 92.5% patients were satisfied with their consultation with mean score of 4.3/5 (5=best,1= worst). More than 80% agreed that all their queries were answered and a clear action plan was formed during consultation. However ,71.2% would want a face to face consultation if given choice while 54 % happy to have further follow up over the phone. 65% of patients preferred not to have video consultation. Subgroup analysis showed that majority of patients who would accept video consultation were aged between 30-39. Most common benefits described were noted to be convenience; reduced time of work; travel time and safety during pandemic, whilst difficulty in describing symptoms; hearing problems; and severity of disease were disadvantages raised, but numbers were small in our cohort. Conclusion Telephone clinics were the mainstay during the COVID-19 pandemic.The large majority of the rheumatology patients in our cohort were highly satisfied with this form of consultation. However, interestingly the majority (71% ) would still prefer face-to-face consultation as follow up in the future. Regular follow up in carefully selected patient groups can successfully be performed by telephone clinics with good patient satisfaction. This would help increase capacity within the clinic setting. Disclosure M. Abdullah: None. N. Heng: None. S. Noor: None. U. Ahmed: None. C. Lavery: None. S. Bawa: None.

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The Impact of Remote Urology Outpatient Clinics during the COVID-19 Pandemic

Journal of Endoluminal Endourology ◽

10.22374/jeleu.v4i3.117 ◽

2021 ◽

Vol 4 (3) ◽

pp. e17-e25

Author(s):

Yehia Abdelmotagly ◽

Mohamed Noureldin ◽

Louise Paramore ◽

Raj Kummar ◽

Timothy Nedas ◽

...

Keyword(s):

Cost Effective ◽

Postal Questionnaire ◽

Telephone Consultation ◽

Face To Face ◽

Level Of Satisfaction ◽

The Future ◽

Specialist Nurses ◽

Remote Patient ◽

The Impact

Introduction: The coronavirus (COVID-19) pandemic of 2020 had a major impact on NHS services. From the 23rd of March 2020, the Urology Department in Basingstoke initiated telephone-led consultation clinicsinstead of face-to-face outpatient appointments, in accordance with U.K. guidance.Objectives: To evaluate patient experience and satisfaction following the introduction of remote (telephone) consultations during the COVID-19 pandemic.Patients and methods: The first 200 remote patient appointments between the 30th of March 2020 and the 16th of April 2020 were sent a postal questionnaire (19 questions relating to their experience and level of satisfaction with the interaction). Telephone consultations were conducted by 6 consultants, 3 registrars, and 2 specialist nurses. The patients were not prewarned to expect a questionnaire after the remote ap-pointment. The associated cost saving resulting from a switch from face-to-face appointments to remote telephone appointments was also calculated.Results: 100 out of the 200 patients responded within 1 month (response rate 50%). A total of 44% of the patients were new referrals, while 56% were follow-ups. Overall, the feedback was positive regarding the telephone consultation, with 88% rating the care received as excellent or very good. In addition, 90% would recommend a telephone consultation to family and friends. However, 35% would prefer in the future to have another telephone consultation rather than face-to-face consultation, with 46% preferring a face-to-face appointment in the future and 19% unsure. For new patients, the proportion wishing to have a face-to-face appointment, in the end, was unsurprisingly higher than it was for those undergoing a follow-up (39% vs. 7 %). In these 2 weeks, the cost reduction to the NHS from shifting from face-to-face consultation to telephone consultation was estimated to be £6500.Conclusions: Telephone urology clinics are a satisfactory alternative to face-to-face appointments for many of our patients now and beyond the COVID-19 pandemic. They are efficient, cost-effective, and feasible to undertake urological consultation and can be implemented successfully in selected patients. The feedback from this questionnaire would suggest that priority should be given to face-to-face appointments for new patients and for complex follow-up appointments. Telephone follow-up appointments, however, are a good approach for the majority of patients.

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Quality and Evaluation Report: Virtual Fracture Clinic at Wythenshawe Hospital

Manchester Medical Journal ◽

10.7227/mmj.0034 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Christian Warner ◽

Anand Pillai

Keyword(s):

Discharge Rate ◽

Royal Infirmary ◽

Fracture Clinic ◽

Face To Face ◽

Discharge Rates ◽

Level Of Satisfaction ◽

Rate Versus ◽

Number Of Patients ◽

Virtual Fracture Clinic

Background: Following its introduction at Glasgow Royal Infirmary in 2011, the Virtual Fracture Clinic model of managing outpatient musculoskeletal injuries has grown significantly in popularity. Wythenshawe Hospital introduced this model to their orthopaedic department in 2015. Aims: How do individual consultants vary in terms of discharge rate versus face-to-face follow up when reviewing cases in a Virtual Fracture Clinic? To assess patients’ level of satisfaction with the management of their injury under a Virtual Fracture Clinic System. Methods: A retrospective study of a cohort of patients over 12 months from 11th May 2017 to 11th May 2018. Data regarding the number of patients reviewed in Virtual Fracture Clinic during this time was collected and the numbers of patients discharged or recalled for follow up analysed. A telephone questionnaire based on the NHS Friends and Family Test was collected from 50 patients within this cohort to assess overall satisfaction with their care. Results: 3361 patients were referred to virtual fracture clinic during the inclusion period. The mean percentage of cases discharged from virtual fracture clinic is 30.4% with a median of 30.5%. The rates of discharge ranged from Consultant G at 13% to Consultant K at 39%. 88% of patients would recommend this service to their friends and family and 80% would rate the service at the level of good or excellent. Conclusion: A virtual fracture clinic model has been successfully implemented at Wythenshawe saving approximately 1157 appointments in 12 months. There is significant variation in discharge rates between consultants which appears to be influenced by the number of patients seen. Individual factors which affect this require further investigation. Patients are very satisfied with their care through the Virtual Fracture Clinic at Wythenshawe Hospital and an overwhelming majority would recommend this to others.

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Remote Consultations Versus Standard Face-to-Face Appointments for Liver Transplant Patients in Routine Hospital Care: Feasibility Randomized Controlled Trial of myVideoClinic (Preprint)

10.2196/preprints.19232 ◽

2020 ◽

Author(s):

Sarah Damery ◽

Janet Jones ◽

Elaine O'Connell Francischetto ◽

Kate Jolly ◽

Richard Lilford ◽

...

Keyword(s):

Patient Satisfaction ◽

Liver Transplant ◽

Usual Care ◽

Real Time ◽

Process Evaluation ◽

Face To Face ◽

Transplant Patients ◽

Qualitative Process Evaluation ◽

Remote Consultations

BACKGROUND Using technology to reduce the pressure on the National Health Service (NHS) in England and Wales is a key government target, and the NHS Long-Term Plan outlines a strategy for digitally enabled outpatient care to become mainstream by 2024. In 2020, the COVID-19 response saw the widespread introduction of remote consultations for patient follow-up, regardless of individual preferences. Despite this rapid change, there may be enduring barriers to the effective implementation of remote appointments into routine practice once the unique drivers for change during the COVID-19 pandemic no longer apply, to which pre-COVID implementation studies can offer important insights. OBJECTIVE This study aims to evaluate the feasibility of using real-time remote consultations between patients and secondary care physicians for routine patient follow-up at a large hospital in the United Kingdom and to assess whether patient satisfaction differs between intervention and usual care patients. METHODS Clinically stable liver transplant patients were randomized to real-time remote consultations in which their hospital physician used secure videoconferencing software (intervention) or standard face-to-face appointments (usual care). Participants were asked to complete postappointment questionnaires over 12 months. Data were analyzed on an intention-to-treat basis. The primary outcome was the difference in scores between baseline and study end by patient group for the three domains of patient satisfaction (assessed using the Visit-Specific Satisfaction Instrument). An embedded qualitative process evaluation used interviews to assess patient and staff experiences. RESULTS Of the 54 patients who were randomized, 29 (54%) received remote consultations, and 25 (46%) received usual care (recruitment rate: 54/203, 26.6%). The crossover between study arms was high (13/29, 45%). A total of 129 appointments were completed, with 63.6% (82/129) of the questionnaires being returned. Patient satisfaction at 12 months increased in both the intervention (25 points) and usual care (14 points) groups. The within-group analysis showed that the increases were significant for both intervention (P<.001) and usual care (P=.02) patients; however, the between-group difference was not significant after controlling for baseline scores (P=.10). The qualitative process evaluation showed that—according to patients—remote consultations saved time and money, were less burdensome, and caused fewer negative impacts on health. Technical problems with the software were common, and only 17% (5/29) of patients received all appointments over video. Both consultants and patients saw remote consultations as positive and beneficial. CONCLUSIONS Using technology to conduct routine follow-up appointments remotely may ease some of the resource and infrastructure challenges faced by the UK NHS and free up clinic space for patients who must be seen face-to-face. Our findings regarding the advantages and challenges of using remote consultations for routine follow-ups of liver transplant patients have important implications for service organization and delivery in the postpandemic NHS. CLINICALTRIAL ISRCTN Registry 14093266; https://www.isrctn.com/ISRCTN14093266 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-018-2953-4

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288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.331 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S144-S144

Author(s):

Azza Elamin ◽

Faisal Khan ◽

Ali Abunayla ◽

Rajasekhar Jagarlamudi ◽

aditee Dash

Keyword(s):

Clinical Outcomes ◽

Antibiotic Treatment ◽

Readmission Rate ◽

Blood Cultures ◽

Categorical Variables ◽

Gram Negative ◽

Number Of Patients ◽

Significant Difference ◽

The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value < 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P < 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P < 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P < 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

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829 Is There an Ongoing Role For 'Telephone Triage Clinics' Post COVID-19?

British Journal of Surgery ◽

10.1093/bjs/znab134.092 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

B Holmes ◽

U Mirza ◽

C Manning ◽

R Cooke ◽

R Jugdey

Keyword(s):

Common Theme ◽

Telephone Triage ◽

Telephone Consultation ◽

Face To Face ◽

Clinician Satisfaction ◽

Set Up ◽

Local Protocol ◽

Telephone Questionnaire

Abstract Introduction COVID-19 has placed unprecedented demand on services at ELHT and it has become necessary to have telephone clinics to reduce the number of face-to-face clinics. A ‘telephone triage clinic’ was set up for referrals from A&E. Our project evaluated patient and clinician satisfaction on this. Method We carried out a retrospective telephone questionnaire with patients over a one-week period during the pandemic. We focussed on overall satisfaction of the consultation and quality of communication. Consultants were also surveyed for their opinion on the clinics. Results From 30 patients, 77% said they were ‘very satisfied’ with the overall experience. 80% of patients were ‘very satisfied’ with the overall length of the telephone consultation. 50% of patients felt the clinician was only ‘adequately’ able to assess them over the telephone. The consultants were less satisfied with the overall experience of telephone consultation. A common theme was that they felt ED documentation could be improved to help inform ongoing management. Conclusions Overall, patients were satisfied with the consultations. It has been successful in minimising face to face consultations however some presentations necessitate further evaluation. We need to identify those injuries appropriate for virtual follow up and design a local protocol for these.

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