scholarly journals P78 Introduction of video consultation into the general rheumatology clinic

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Sian M Griffith ◽  
Eleanor Brewer
Keyword(s):  
Work Force ◽  
Video Technology ◽  
Outpatient Services ◽  
Waiting Room ◽  
Rheumatology Clinic ◽  
Face To Face ◽  
Number Of Patients ◽  
Video Consultation ◽  
Car Park

Abstract Background An expansion in consultant work force and increasing demand for outpatient services has led to a shortage of clinic space to run clinics, overcrowding in waiting rooms, and lack of space in patient car parks. We therefore decided to trial a video consulting technology that is used in remote areas by NHS Scotland, in an urban rheumatology clinic. Methods All follow up patients due to attend a weekly rheumatology clinic were contacted by letter 2-4 weeks before their appointment, and invited to opt for video consultation. Patients were asked not to use the service if they were likely to need a physical examination or procedure such as joint injection. The participating consultant then provided her usual clinic at the usual time using a mixture of face to face and video consultations. The service was evaluated by looking at the number of patients opting for this service, age and diagnosis of participating patients, and feedback from patients and consultant. Results Between 1 September and I October 2019, 77 patients were invited to attend, of which 12 patients requested video consultation. 2 patients did not attend their video consultation meaning 10 patients (13%) participated in the initial pilot. The average age of participants was 53 (range 36 to 68): 6 female, 4 male. The patients had the following diagnoses: rheumatoid arthritis (5), psoriatic arthritis (3), ankylosing spondylitis (1), and fibromyalgia (1). 7 patients gave feedback (4 male: 3 female). 7/7 rated process of booking and joining video consultation good or very good, 7/7 satisfied with picture quality, 4/7 satisfied with sound quality, 7/7 able to communicate everything they wanted to the doctor during the consultation. 6/7 rated the experience as the same as a face to face consultation, 1/7 better. 7/7 happy to have further consultations using video technology. In terms of time saved travelling to outpatients less than one hour (2), 1-2 hours (4), 2-3 hours (1).The feedback from the consultant was that clinic time was saved by using video consultations, and that all patients who had selected the technology has done so appropriately. Conclusion Inviting all rheumatology follow-up patients to use video technology for consultation resulted in 13% fewer patients attending the outpatient clinic, reducing congestion in the patient car park and clinic waiting room. Patients opted appropriately for such consultations, as none needed to return on another occasion for further consultation. The video consultations took less time than face to face consultations, saving time in the clinic. The overall patient and doctor satisfaction with the technology was good, and patients saved significant time on travel to the clinic. Disclosures S.M. Griffith None. E. Brewer None.

scholarly journals Are telephone consultations here to stay in rheumatology?

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.

scholarly journals Establishing a nurse-led thyroid cancer follow-up clinic

2021 ◽  
Vol 30 (4) ◽  
pp. S28-S35
Author(s):  
Andrew Fishburn ◽  
Nicola Fishburn
Keyword(s):  
Thyroid Cancer ◽  
Complex Disease ◽  
Disease Recurrence ◽  
Patient Survey ◽  
Safe Patient Care ◽  
Face To Face ◽  
Number Of Patients ◽  
Risk Of Disease

Thyroid cancer is a complex disease requiring management by a large multidisciplinary team. The number of patients with a diagnosis of thyroid cancer is significantly increasing year-on-year, and traditional models of consultant-led follow up are no longer sustainable. Although nurse-led cancer follow-up clinics are becomining increasingly common, thyroid cancer nurse-led follow-up clinics are rare. An excellent understanding of the disease, treatment and management of risk of disease recurrence is essential for safe patient care, and is discussed in this article. The clinic discussed uses the skill set of head and neck nurse specialists, including psychological support, coping strategies for long-term side effects of treatment and non-medical prescribing. A patient survey of the service revealed high levels of patient satisfaction and a desire to continue face-to-face consultations rather than telephone clinics.

scholarly journals Education in Neurology Resident Documentation Using Payroll Simulation

2017 ◽  
Vol 9 (2) ◽  
pp. 231-236 ◽  
Author(s):  
John W. Liang ◽  
Vicki L. Shanker
Keyword(s):  
Medical Decision ◽  
Financial Loss ◽  
Income Loss ◽  
Face To Face ◽  
Number Of Patients ◽  
Specific Feedback ◽  
Didactic Lecture ◽  
E Mail

ABSTRACT Background Approaches for teaching neurology documentation include didactic lectures, workshops, and face-to-face meetings. Few studies have assessed their effectiveness. Objective To improve the quality of neurology resident documentation through payroll simulation. Methods A documentation checklist was created based on Medicaid and Medicare evaluation and management (E/M) guidelines. In the preintervention phase, neurology follow-up clinic charts were reviewed over a 16-week period by evaluators blinded to the notes' authors. Current E/M level, ideal E/M level, and financial loss were calculated by the evaluators. Ideal E/M level was defined as the highest billable level based on the documented problems, alongside a supporting history and examination. We implemented an educational intervention that consisted of a 1-hour didactic lecture, followed by e-mail feedback “paystubs” every 2 weeks detailing the number of patients seen, income generated, income loss, and areas for improvement. Follow-up charts were assessed in a similar fashion over a 16-week postintervention period. Results Ten of 11 residents (91%) participated. Of 214 charts that were reviewed preintervention, 114 (53%) had insufficient documentation to support the ideal E/M level, leading to a financial loss of 24% ($5,800). Inadequate documentation was seen in all 3 components: history (47%), examination (27%), and medical decision making (37%). Underdocumentation did not differ across residency years. Postintervention, underdocumentation was reduced to 14% of 273 visits (P < .001), with a reduction in the financial loss to 6% ($1,880). Conclusions Improved documentation and increased potential reimbursement was attained following a didactic lecture and a 16-week period in which individual, specific feedback to neurology residents was provided.

scholarly journals P066 Telephone clinics: what are our patients saying?

Rheumatology ◽  
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.

scholarly journals P072 Tele-rheumatology: outcomes from the COVID-19 pandemic

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Samir Patel ◽  
Pamela Lutalo ◽  
Ghada Yanni ◽  
Louise Pollard
Keyword(s):  
University Hospital ◽  
Satellite Monitoring ◽  
Patient Specific ◽  
Great Promise ◽  
Outpatient Services ◽  
Allied Health Professionals ◽  
Palindromic Rheumatism ◽  
Telephone Consultation ◽  
Face To Face

Abstract Background/Aims  The COVID-19 pandemic resulted in significant disruption to outpatient services, with hospital resources redirected to acute medical and critical care units. Social distancing measures meant that routine face-to-face outpatient appointments needed to be cancelled or reimagined. Telemedicine offered an attractive solution. Telemedicine uses technology to increase access to healthcare and has been used internationally in remote clinical settings, the National Health Service’s ‘111’ as well as in the National Aeronautics and Space Administration (NASA). Methods  The University Hospital Lewisham Rheumatology Department organised outpatient review of new and follow-up patients via a consultant-supervised registrar telephone clinic 5 days a week during the first-wave of the COVID-19 pandemic. 278 patients had a telephone consultation with the registrar over a 3-month period (30 March to 30 June 2020): 197 new and 81 follow-up patients. Results  Of the 197 new patient referrals: 2% required urgent face-to-face review (new inflammatory arthritis); 31% were provided with future routine clinic appointments and 44% were discharged: 35 patients without the need for any further investigations and 52 patients following subsequent investigations (e.g. phlebotomy and radiology). Patients were provided with management advice, links to online resources and referred to allied health professionals as indicated, e.g. physiotherapy. Patients were effectively discharged following telephone consultation if the history was sufficient to exclude a condition requiring secondary care management and if relevant community investigations were negative (including inflammatory markers and immunology). 62 of the 197 newly referred patients were offered a routine follow-up appointment. 36 of these patients were reviewed in person when COVID-19 restrictions eased. Of these 36 patients, 20 were subsequently discharged, diagnoses included: chronic pain (5), osteoarthritis (3), mechanical joint pain (6). 11 patients remained for follow up, diagnoses included: Sjögren’s syndrome (2) and palindromic rheumatism (1). 5 patients did not attend. Conclusion  The strengths of this model were: the ability to continue to provide an outpatient rheumatology service; provide safe and effective management for new and follow-up patients; provide patient specific advice pertaining to COVID-19 and to support patients and primary care clinicians. The weaknesses of this model were the use of a single practitioner. Video consultation was not available when this model was implemented, but should add further to subsequent services. Our experience with the tele-rheumatology model suggests that a telephone triage system, coupled with relevant investigations prior to referral could lead to an effective virtual management strategy with potential beyond the COVID-19 pandemic. It also has great promise with regards to managing chronic conditions in clinical remission with video or telephone consultations, utilising virtual disease activity scores (ePROMS now available via the BSR) and satellite monitoring of blood tests and urinalysis. As technology continues to advance, we should explore ways to modernise the outpatient services. Disclosure  S. Patel: None. P. Lutalo: None. G. Yanni: None. L. Pollard: None.

The Nordic comparative study on sectorized psychiatry: characteristics of repeat users of emergency outpatient services in two Nordic psychiatric services. A 1-year follow-up study

1998 ◽  
Vol 13 (1) ◽  
pp. 35-40 ◽  
Author(s):  
O Saarento ◽  
M Kastrup ◽  
L Hansson
Keyword(s):  
Hospital Admissions ◽  
Psychiatric Services ◽  
Outpatient Services ◽  
Frequent Use ◽  
Number Of Patients ◽  
Diagnostic Characteristics ◽  
Sectorized Psychiatry ◽  
One Year ◽  
Prospective Investigation

SummaryTo characterise frequent use of psychiatric emergency outpatients services, this paper reports results from a prospective investigation of use of psychiatric services by new patients in two Nordic psychiatric services, Frederiksberg in Denmark and Oulu in Finland. One year treated incidence cohorts were used. Total number of patients included was 1,055. The repeat user was defined as a patient having at least three emergency outpatient contacts during a 1-year follow-up. The repeat users constituted 15.8% of the sample and 70.8% of all the emergency contacts in Frederiksberg. In Oulu the respective figures were 9.3% and 33.8%. The number of planned outpatient contacts or the number of hospital admissions of the repeat users did not differ from the non-repeaters. Repeaters in Frederiksberg were more likely to be self-referrals, male, divorced or unmarried, living with their parents, without their own housing, unemployed, aged between 25 and 44 years, and to have a diagnosis of dependency or personality disorder. In Oulu they did not differ from the other patients with regard to sociodemographic or diagnostic characteristics.

scholarly journals Re-admissions to hospital and patient satisfaction among patients with chronic obstructive pulmonary disease after telemedicine video consultation - a retrospective pilot study

2014 ◽  
Vol 9 ◽  
Author(s):  
Safaa Saleh ◽  
Jan Petter Larsen ◽  
Johannes Bergsåker-Aspøy ◽  
Heidi Grundt
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Patient Satisfaction ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Number Of Patients ◽  
Video Consultation ◽  
The Impact

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of acute hospital admissions. The main object of our study was to evaluate the effects of telemedicine video-consultation (TVC) on the frequency of hospital re-admissions due to COPD exacerbations. Our secondary aim was to assess the impact of TVC on the length of re-admission stays within 6 and 12 months follow up after TVC. Patient satisfaction was also evaluated. Methods: The study was a retrospective observational study of COPD patients who after hospital discharge or during outpatient treatment for acute COPD exacerbations, were monitored for 2 weeks by TVC at home by a specialist nurse at the hospital during a pilot project period. Retrospectively, we compared the frequencies (chi-square test) and durations of hospital re-admissions (paired t-test) due to COPD exacerbations within 6 and 12 months follow up after TVC to comparable events 6 and 12 months prior to TVC. Results: Among 99 patients followed for 6 months after TVC, 56 were followed for totally 12 months. The number of patients re-admitted and the number of re-admissions due to COPD exacerbations were not reduced within 6 or 12 months post-TVC, as compared to 6 and 12 months pre-TVC. The mean length of re-admission stays within 12 months post-TVC was markedly reduced as compared to pre-TVC. Patients hospitalised the last 6 and 12 months pre-TVC, had significantly shorter re-admission stays, p = 0.033 and p = 0.001, respectively. Patient satisfaction was high. Conclusion: Despite the failure to demonstrate reduced frequency of re-admissions within 6 and 12 months post-TVC, the re-admission length within 12 months post-TVC was markedly reduced as compared to pre-TVC. The patient satisfaction was high. Future prospective, randomised, controlled trials must be performed before TVC can be recommended in COPD management.

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

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv14-iv14
Author(s):  
Emma Toman ◽  
Claire Goddard ◽  
William Garratt ◽  
Frederick Berki ◽  
Zenab Sher ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Family Member ◽  
Telephone Consultation ◽  
Face To Face ◽  
Oncology Service ◽  
Level Of Satisfaction ◽  
Number Of Patients ◽  
Significant Difference ◽  
Remote Consultations

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.

scholarly journals Quality and Evaluation Report: Virtual Fracture Clinic at Wythenshawe Hospital

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.

Experiences From a Combined Dermatology and Rheumatology Clinic

2016 ◽  
Vol 20 (5) ◽  
pp. 486-489 ◽  
Author(s):  
Michael Samycia ◽  
Collette McCourt ◽  
Kam Shojania ◽  
Sheila Au
Keyword(s):  
Lupus Erythematosus ◽  
Rheumatology Clinic ◽  
Patient Demographics ◽  
Included Patient ◽  
Number Of Patients ◽  
Treatment Clinic ◽  
Multidisciplinary Clinic ◽  
Period Data ◽  
Cutaneous Lupus

Background: The Dermatology and Rheumatology Treatment Clinic is a novel multidisciplinary clinic where patients are concomitantly assessed by a rheumatologist and dermatologist. Objectives: To determine the number of patients seen in clinic, patient demographics, and most common diagnoses. Method: A retrospective review was performed over a 2-year period. Data collected included patient age, sex, dermatologic diagnosis, rheumatologic diagnosis, biopsies performed, and number of follow-up visits. Results: A total of 320 patients were seen (78% female, 22% male). The most common rheumatologic diagnoses were systemic lupus erythematosus (18%), rheumatoid arthritis (15%), psoriatic arthritis (13%), and undifferentiated connective tissue disease (8%). The most common dermatologic diagnoses were dermatitis (17%), psoriasis (11%), cutaneous lupus (7%), various types of alopecia (6%), and infections (5%). Conclusions: Skin diagnoses were often unrelated to the underlying rheumatologic diagnosis. Rheumatologists and dermatologists can both benefit from being aware of the dermatologic conditions that rheumatologic patients are experiencing.

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