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

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.

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TP10.2.9The effect of COVID-19 on Breast clinic follow ups – a change in future practice?

British Journal of Surgery ◽

10.1093/bjs/znab362.146 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Carol Norman ◽

Lilia Ragad ◽

Anupama Nagarajakumar ◽

Maryam Alam Khan ◽

Michal Uhercik ◽

...

Keyword(s):

University Hospital ◽

Electronic Patient Records ◽

Breast Clinic ◽

Telephone Consultation ◽

Face To Face ◽

Video Telephone ◽

Malignant Breast ◽

The Uk ◽

Future Practice

Abstract Aims Prior to March 2020, at Princess Royal University Hospital (PRUH), Kings College NHS Foundation Trust, almost daily face to face benign/malignant breast clinic follow ups occurred. On March 23rd 2020 the UK went into official COVID-19 pandemic lockdown. The effect on elective follow up practice was swift with cancellation, triaging and replacement of face-to-face by telephonic/virtual consultations. We compared the change of follow up pattern, pre and post COVID-19. Could this effect the future of consultations at PRUH? Methods A comparison of all patients attending PRUH breast unit outpatients in January 2020 (preCOVID-19) for follow up, with those attending in April 2020 (postCOVID-19). Data collection from clinic lists and electronic patient records, with Excel version 16 analysis. Results 343 patient follow up consultations 01/2020. 53 patient follow up consultations 04/2020. Malignant cases: January 65%, April 60% Benign/B3 cases: January 35%, April 20% Summary follow up types. Conclusions Impact of COVID has been widespread in our practice. Our results show a significant reduction in face-to-face appointments, to allow social distancing. Further evaluation of this model will show its sustainability. Patient satisfaction will have to be assessed, with a view to a full move to video/telephone consultation where indicated.

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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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Implementation of podiatry telephone appointments for people with rheumatic and musculoskeletal diseases

Journal of Foot and Ankle Research ◽

10.1186/s13047-020-00441-9 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

J. L. Palmer ◽

H. J. Siddle ◽

A. C. Redmond ◽

B. Alcacer-Pitarch

Keyword(s):

Musculoskeletal Diseases ◽

Cost Effective ◽

Time Frame ◽

Teaching Hospitals ◽

Potential Cost ◽

Foot Health ◽

Telephone Consultation ◽

Face To Face ◽

Initial Intervention

Abstract Background Foot health problems are common in the general population, and particularly so in people with rheumatic and musculoskeletal disorders (RMD). Several clinical guidelines state that people with RMDs should have access to foot health services, although service capacity is often limited. The current COVID-19 pandemic has increased the need for alternative ways to provide patient care. The aim of this clinical audit was to review a newly implemented telephone follow-up appointment service conducted within the Rheumatology Podiatry Department in Leeds, UK. Methods Fifty-eight patients attending the Rheumatology Podiatry Department at Leeds Teaching Hospitals NHS Trust were contacted by telephone approximately 6–8 weeks following initial intervention. During the telephone consultation, all patients were asked pre-defined questions relating to their symptoms, intervention efficacy, the need for further appointments and their preference for the type of consultation. To assess the cost of the telephone consultation the number of attempts needed in order to make successful contact, the duration of the call and the number of telephone follow-up appointments completed in a working day were also recorded. Results Twenty-five patients (43%) were successfully contacted within the 6–8 weeks stipulated time frame and were included in the analysis. Of the 25 contacted, twelve (48%) patients were successfully contacted on the first attempt. Ten (40%) were successfully contacted on the second attempt. The remaining three patients (12%) required 3 or more attempts to make successful contact. Telephone consultations were estimated not to last longer than 10 min, including notes screening and documentation. Eleven patients (44%) reported an improvement in their symptoms, thirteen (52%) reported no change and one patient (4%) reported their symptoms to be worse. Conclusion Telephone follow-up consultations may be a potentially cost-effective alternative to face-to-face appointments when implemented in a Rheumatology Podiatry Department, and provide an alternative way of providing care, especially when capacity for face-to-face contact is limited. The potential cost saving and efficiency benefits of this service are likely to be enhanced when telephone consultations are pre-arranged with patients.

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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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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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The Effect of Telemedicine on Patients’ Compliance in Family Medicine Follow-ups in Qatar

Avicenna ◽

10.5339/avi.2022.3 ◽

2021 ◽

Vol 2022 (1) ◽

Author(s):

Yaman M. AlAhmad ◽

Duaa Mahmoud Haggeer ◽

Abrar Yaser Alsayed ◽

Mahmoud Y. Haik ◽

Leen Maen AbuAfifeh ◽

...

Keyword(s):

Health Care ◽

Family Medicine ◽

Health Care Services ◽

Healthcare Services ◽

Cross Sectional Study ◽

Cross Sectional ◽

Telephone Consultation ◽

Face To Face ◽

Primary Health Care Centers

Introduction: Telemedicine is the delivery of health care services to patients distantly. During the Coronavirus Disease 2019 (COVID-19) pandemic, telemedicine has become an essential implement in delivering healthcare services worldwide. Accordingly, in March 2020, the Primary Health Care Centers (PHCCs) in Qatar has started telephone consultation follow-up appointments in Family Medicine (FM) clinics instead of conventional consultation. Given the limited data about telephone consultations in Qatar, our aim of this study is to investigate the possible impact of telemedicine on chronic disease patients’ follow-up compliance. Methods: This study compares the compliance of adult patients with chronic diseases following-up within FM clinics in Qatar's PHCC through telephone consultations with a minimum of three telephone consultations ordered between April to November 2020, in comparison to the compliance of the same group of patients to their prior face-to-face follow-up consultations in FM clinics with a minimum of three face-to-face ordered follow up appointments between April to November 2019. A cross-sectional study will be carried out to investigate the effect of telephone consultation in PHCC on patients’ compliance with reference to conventional face-to-face consultation. Patients’ data will be received from Health Information Management in twenty-seven PHCCs in Qatar. Conclusion: Due to the limited studies on the effectiveness of telemedicine on patient compliance in FM follow-ups within Qatar's PHCC, comparing patients’ follow-up compliance with telephone consultations to their prior face-to-face consultations would be helpful in assessing patients’ quality of care delivering within FM clinics. With telecommunication being easily accessible and time-efficient, it is believed, when used correctly, it might improve compliance and adherence to the management prescribed by the physician and follow-up appointments in Qatar's PHCC. In addition, this study will help in providing recommendations that could guide the organization on forming policies to be applied in PHCCs after the resolution of the COVID-19 pandemic.

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Self-Extubation in the Surgical Intensive Care Unit and Restraint Policy Change: A Retrospective Study

Open Medicine Journal ◽

10.2174/1874220301401010010 ◽

2014 ◽

Vol 1 (1) ◽

pp. 10-14 ◽

Cited By ~ 1

Author(s):

John T. Denny ◽

Enrique Pantin ◽

Julia Denny ◽

William Grubb ◽

James Tse ◽

...

Keyword(s):

Intensive Care ◽

Policy Change ◽

Initial Study ◽

University Hospital ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Face To Face ◽

Life Threatening ◽

Recent Policy

Background:Self-extubation is a serious complication of mechanical ventilation. The incidence of self-extubation in a university hospital may be altered by a recent policy change, which requires daily written and face-to-face patient re-evaluations regarding the need for restraints in the intensive care units. There are many concerns and suspicions that this might result in less use of restraints and thereby increase the risk of self-extubation.Methods:The goal of this study was to describe the incidence of self-extubation (SE) over time and report any observed change with the change in restraint policy (RP).Results:The rate of self-extubation during the control year was 1.62% which increased to 2.33% during the initial study period and decreased to 1.30% in the following year. The distant follow-up period eight years after the initial change in restraint policy showed a rate of 1.14%. Apache scores did not differ significantly between the years compared.Conclusion:A new restraint policy, which requires frequent reordering by physicians, has the potential to be associated with increased self-extubation, at least temporarily. Staff education may help reduce this risk. Further research will be useful in clarifying which interventions can most reduce this potentially life-threatening complication.

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P78 Introduction of video consultation into the general rheumatology clinic

Rheumatology ◽

10.1093/rheumatology/keaa111.076 ◽

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.

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P070 Tele-consultations from the patient’s perspective: during the pandemic and beyond

Rheumatology ◽

10.1093/rheumatology/keab247.068 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Natasha Cleaton ◽

Sabrina Raizada

Keyword(s):

Older Patients ◽

Significant Proportion ◽

Clinical Excellence ◽

Vulnerable Groups ◽

British Society ◽

Younger Patients ◽

Telephone Consultation ◽

Face To Face ◽

Increased Risk

Abstract Background/Aims The current COVID-19 pandemic has challenged healthcare systems worldwide stimulating a transformation of NHS services to cope with increased acute demand, while aiming to minimise viral transmission. A significant proportion of rheumatology patients are considered ‘clinically extremely vulnerable’ and are at increased risk of COVID-19. With this in mind, alongside national guidance from the British Society for Rheumatology and the National Institute of Clinical Excellence we adapted our services in response to COVID by mostly suspending face-to-face appointments for follow up patients, instead relying on telephone or virtual consultations with a face-to-face appointment if necessary in order to minimise risk to our patients. We aimed to evaluate our use of telephone consultations during the pandemic and gain understanding of our patients views of telephone consultations longer term. Methods We retrospectively surveyed rheumatology patients under active follow-up at the royal Wolverhampton trust who had a telephone consultation with a rheumatology consultant over a 4-week period (11/5/20- 4/6/20). Patients were invited to participate via a SMS text message containing an embedded web-link to the survey. Results were analysed using SPSS version 26. Results Surveys were sent to 1,213 patients; 306 (25.2%) patients completed the survey. Responders were mostly female; the predominant diagnosis was inflammatory arthritis. Ages included: 1 (0.3%) patient 16-29 years, 46 (15.0%) 30-49, 180 (58.8%) 50-69, and 79 (25.8%) aged >70 years. Regarding their telephone consultation, 86.6% of responders were satisfied with the consultation. During the current pandemic 81.4% of responders were pleased to have a telephone consult rather than face-to-face; 57.2% of responders would be happy for their next routine appointment to be a telephone clinic. A significantly higher proportion of patients <50 years preferred telephone consultations when compared to older patients (Chi2 [DF = 3]= 10.075, P = 0.018) and more younger patients had access to a smartphone than those in the older cohort (Chi2 [DF 3]= 20.919, P = <0.001). Conclusion Overall, the short-term switch to telephone consultation was well received by our cohort. The majority of patients were satisfied with their telephone consultation and most were pleased to have a telephone consult rather than a face-to-face appointment in the current pandemic. Just over half would be happy for their next routine appointment to be a telephone consultation, however, a significantly higher proportion of younger patients prefer telephone consultations compared to older patients and a greater number of younger patients have access to a smartphone compared to older patients. Further planning is required to ensure patients in older and other vulnerable groups are not excluded should telephone clinics become a more permanent fixture. Disclosure N. Cleaton: None. S. Raizada: None.

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Development and outcomes of a virtual triage pathway for cancer diagnosis in vague symptom patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.326 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 326-326

Author(s):

Kathryn Tremble ◽

Maria J. Monroy-Iglesias ◽

Sabine Martin ◽

Geraint Jones ◽

Charlotte Moss ◽

...

Keyword(s):

High Risk ◽

Cancer Diagnosis ◽

Low Risk ◽

Watch And Wait ◽

Benign Condition ◽

Telephone Consultation ◽

Face To Face ◽

Diagnosis Rate ◽

Risk Patients

326 Background: At the Rapid Access Diagnostic Unit at Guy’s Hospital London, we review patients with vague symptoms that are concerning for malignancy. As part of our response to the COVID-19 pandemic, we developed a virtual triage pathway with the aim to reduce face-to-face appointments and prioritise resources towards patients with an underlying cancer diagnosis. Methods: Patients were triaged by clinicians based on a telephone consultation with the patient and history and blood tests provided in the referral. Those triaged as high risk were either directly booked for investigation (“straight-to-test”) or booked for a face-to-face consultation for further history and examination. Low risk patients were either put on a watch-and-wait pathway with a telephone follow-up in 3-4 weeks or discharged back to the GP with a robust plan on symptom management. The patient outcomes were tracked and compared to the outcomes from the face-to-face assessment service used prior to the COVID-19 pandemic (Dec 2016-Feb 2020). Patients triaged as low risk and discharged were tracked to monitor for any subsequent cancer diagnoses. Results: There were 804 referrals triaged between March 2020-January 2021. 75% were triaged to a face-to-face assessment and 18% triaged straight-to-test. 4% were placed on the watch-and-wait pathway and 3% were returned to the GP with advice. In those triaged as high risk, 8.2% were diagnosed with cancer, 54% were diagnosed with a serious-benign condition and 38% with a non-serious or no condition. In the patients triaged as low risk and placed on the watch-and-wait pathway, 14% were brought in for a face-to-face assessment based on their follow-up telephone assessment. None of the patients on the watch-and-wait pathway were found to have a cancer diagnosis, 11% were diagnosed with a serious-benign condition, and 89% were diagnosed with a non-serious or no condition. There was an overall cancer diagnosis rate of 7.6% compared with a pre-COVID-19 diagnosis rate of 6.6%. Conclusions: The virtual triage pathway effectively risk-assessed patients, with those triaged as high risk having an 8.2% cancer diagnosis rate compared to a 0% cancer diagnosis rate in those triaged as low risk. Furthermore, the virtual triage service had a higher cancer diagnosis rate compared to the pre-COVID-19 face-to-face assessment service. Therefore the virtual triage service provides an efficient pathway for cancer diagnosis in patients presenting with vague symptoms, reducing the number of face-to-face appointments and supporting management of low risk patients in the community.

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