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

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

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

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

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

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

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

Rheumatology ◽  
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.

scholarly journals Diagnostic stability in a Dutch psychosis incidence cohort

2004 ◽  
Vol 185 (6) ◽  
pp. 460-464 ◽  
Author(s):  
Natalie D. Veen ◽  
Jean-Paul Selten ◽  
Diede Schols ◽  
Winfried Laan ◽  
Hans W. Hoek ◽  
...  
Keyword(s):  
Psychotic Disorders ◽  
Population Based ◽  
Schizophrenic Disorder ◽  
Diagnostic Stability ◽  
Face To Face ◽  
Follow Up Study ◽  
Relative Risks ◽  
Diagnostic Interviews ◽  
The Uk

BackgroundNo study outside the UK has examined the diagnostic stability of psychotic disorders in a population-based sample.AimsTo determine diagnostic stability in a Dutch population-based psychosis incidence cohort, to examine the frequencies of diagnostic shifts to and from schizophrenic disorders and to report the revised relative risks of schizophrenic disorders for immigrants.MethodA 30-month follow-up study assessed the cohort (n=181) by means of face-to-face diagnostic interviews.ResultsDiagnostic stability of schizophrenic disorders was high (91%), but lower for other psychotic disorders. At follow-up, the initial diagnosis was adjusted to schizophrenic disorder more often than that the reverse occurred. Almost half (49%) of the patients who were not initially diagnosed as having a schizophrenic disorder received this diagnosis at follow-up. The relative risks for most immigrant groups were stable.ConclusionsSchizophrenic disorders are underdiagnosed, rather than overdiagnosed, at first presentation.

scholarly journals 885 Telephone Consultations During the Covid-19 Pandemic; from the Perspective of One Oral and Maxillofacial Unit

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Chaudhry ◽  
J Abiola
Keyword(s):  
Emergency Treatment ◽  
Electronic Patient Record ◽  
Ad Hoc ◽  
Healthcare Provision ◽  
Face To Face ◽  
Global Impact ◽  
The Uk ◽  
Benign Biopsy

Abstract Introduction The Covid-19 pandemic has had a global impact on healthcare. As a result, changes have been made to healthcare provision. In the UK, the focus was changed to urgent and emergency treatment only, and therefore a shift from face-to-face consultations to video and telephone consultations was implemented. Our aim was to look at the telephone consultations in our oral and maxillofacial (OMF) department to identify their effectiveness. Method A search was carried out using the electronic patient record for patients booked for consultations in the OMF clinics from the 23rd of March to the 1st of May 2020. Trauma clinics and ad-hoc clinics were excluded. Results 21 clinic codes were found as suitable for inclusion. 185 consultations were booked during the 6-week period. Of these, 165 were via telephone and 20 face-to-face. A total of 75 consultations resulted in discharge and 110 required further follow up or further investigation. Of the 75 patients discharged, 73 of these were via telephone. The main reason for discharge was delivery of benign biopsy results. Conclusions Covid-19 will have long term impacts on healthcare provision. If implemented correctly, virtual consultations carry the potential in making healthcare more accessible.

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

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.

scholarly journals 110 Participants and Volunteer Host Experiences of First Steps Course for Those Newly Diagnosed with Parkinson’s: A Qualitative Study

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i37-i37
Author(s):  
E R Bodger ◽  
K Ibrahim ◽  
H C Roberts
Keyword(s):  
Information Support ◽  
Newly Diagnosed ◽  
Clinical Environment ◽  
Structured Interviews ◽  
Face To Face ◽  
Lack Of Information ◽  
Lack Of Control ◽  
The Uk ◽  
And Control

Abstract Introduction People with Parkinson’s (PwP) and their caregivers often report poor diagnosis experiences and a lack of information, support and control over Parkinson’s. First Steps is a two-day course delivered by volunteers with Parkinson’s, which aims to help those newly diagnosed and their caregivers face the future positively and take control of Parkinson’s. This study aimed to capture the views and experiences of participants and volunteer hosts of First Steps, and evaluate if it meets those aims. Methods Using purposive sampling, twelve participants comprising four PwP, five caregivers and three volunteer hosts were recruited. Face-to-face, semi-structured interviews were conducted, audio-recorded, transcribed verbatim and analysed thematically. Results Course participants found First Steps informative, supportive, and helpful in feeling more positive about Parkinson’s. Participants were reassured by the hosts having Parkinson’s, despite prior concerns regarding seeing people who might have more advanced Parkinson’s. Some found First Steps more relatable than other support services and reported that the course complemented clinician-led courses as the content was aimed at caregivers as well as PwP, with variation in information delivery techniques. Among the PwP and caregivers, two thirds reported a lack of control over Parkinson’s and some felt First Steps had improved their control. Hosts felt they had control over Parkinson’s and perceived their role to be both challenging and rewarding. Conclusions First Steps was perceived as a helpful course, offering information and support for those newly diagnosed and their caregivers in a positive and non-clinical environment. Volunteer hosts felt more control over Parkinson’s than other participants, but there was evidence that the course helped some experience more control. Suggested course improvements included: additions to the presentation content with more emphasis on taking control, and offering group follow up sessions. This will inform current expansion across the UK.

scholarly journals An evaluation of a manualised group self-esteem programme for Anorexia Nervosa patients regaining weight

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Hannah Biney ◽  
Matt Hutt ◽  
Rachel Matthews ◽  
Hubert Lacey
Keyword(s):  
Anorexia Nervosa ◽  
Strong Predictor ◽  
Self Esteem ◽  
Service Evaluation ◽  
Behavioural Therapy ◽  
Primary Diagnosis ◽  
Paired Samples ◽  
Cognitive Behavioural ◽  
The Uk

Low self-esteem has been identified as a strong predictor of onset, maintenance and relapse in eating disorders. This suggests that treatment directly addressing low self-esteem might improve recovery. The Cognitive Behavioural Therapy (CBT) based group for low self-esteem is a six session manualised programme based on Melanie Fennel’s model for low self-esteem. It was developed at Newbridge House, a child and adolescent eating disorder inpatient unit in the UK. Although the use of CBT for low self-esteem is established in adult services, the Newbridge programme, adapting the same principles for children and adolescents, is to our knowledge, the first of its kind. This paper reports a service evaluation (N=63) which examines the efficacy of this group in improving low self-esteem for 12-17 year olds with a primary diagnosis of Anorexia Nervosa (AN). Paired-samples t-tests compared the differences in pre- to post-group and post-group to follow-up. Results indicate significant improvements in self-esteem as shown by improvements on the Rosenberg Self-Esteem scale, which are maintained at follow-up. This highlights that group manualised CBT for low self-esteem is effective for young people with AN and indicates the need for future controlled studies.

scholarly journals General paediatric surgery for patients aged under 5 years: a 5-year experience at a district general hospital

2016 ◽  
Vol 98 (7) ◽  
pp. 479-482 ◽  
Author(s):  
C-S Kwok ◽  
AC Gordon
Keyword(s):  
District General Hospital ◽  
Complication Rates ◽  
Paediatric Surgery ◽  
Day Case ◽  
Day Case Surgery ◽  
Surgical Trainees ◽  
Case Surgery ◽  
The Uk ◽  
Training Opportunities ◽  
Electronic Hospital

Introduction The gradual shift of general paediatric surgery (GPS) provision from district general hospitals (DGH) to specialised units is well recognised in the UK. The consequences of centralisation include a reduction in exposure to GPS for current surgical trainees. The GPS practice of a DGH is examined here. Methods All operations performed on children aged under 5 years over a 5-year period were identified using the local electronic operation database. Electronic hospital records and clinic letters were accessed to collect data on demographics, operations performed and outcome measures. Results 472 GPS operations were performed on children between the age of 22 days and 5 years between 2009 and 2014, of which 43 were on an emergency basis and 105 were performed on patients aged less than 1 year. Three patients were admitted following day case surgery. Six patients were readmitted within 30 days. Complication rates for all procedures and the four most common procedures were similar to those found in published literature. Conclusions GPS for patients aged less than 5 years is comparatively safe in the DGH setting. The training opportunities available at DGHs are invaluable to surgical trainees and vital for sustaining the future provision of GPS by such hospitals.

scholarly journals 426 An Evaluation of The Service of Endoscopic Trans-Sphenoidal Surgery for Excision of Pituitary Lesion During The SARS-Cov-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Cernei ◽  
S Sinha
Keyword(s):  
Pituitary Surgery ◽  
Mass Effect ◽  
Positive Outcome ◽  
Service Evaluation ◽  
Face To Face ◽  
Remote Services ◽  
Biopsychosocial Perspective ◽  
Pituitary Lesion

Abstract Introduction Since the start of SARS-CoV-2 pandemic many branches of medicine and surgery have undergone changes shifting the focus to prepare for an increase of COVID-19 related admissions. Halting all pituitary surgery services was not feasible particularly if patients present with acute or progressive visual loss due to the mass effect of the pituitary lesion, pituitary apoplexy, or lesions with aggressive features. Method An 11-point telephone questionnaire was used to evaluate the service provided between March and September 2020. On a 1-10 scale, patients scored their feelings about remote clinics, the support offered, the clarity of explanations, quality of interaction with their surgeon, and an overall assessment of remote clinics. Results 20 of the 21 patients who underwent transsphenoidal pituitary lesion resection between the 02/03/2020 and 14/09/2020 participated in the survey. They unanimously felt the introduction of remote consultations was necessary and felt safer. Their surgeon’s communication skills helped their experience the most. It allowed for easier attendances as they did not rely on family or long travelling times. Drawbacks involved the lack of face-to-face interaction particularly pre-operatively, as patients felt they missed the human factor, seeing their scans, and meeting their surgeon in person. Conclusions The pandemic has affected people from a biopsychosocial perspective leaving long-lasting effects on the economy and healthcare systems of the world. This service evaluation highlights a positive outcome in terms of patient experience. Moving forward, incorporating remote services as an option for follow-up cases would be welcomed by most patients in the survey.

scholarly journals Converting From Face-to-face to Postal Follow-up and Its Effects on Participant Retention, Response Rates and Errors: Lessons from the EQUAL study in the UK.

2021 ◽  
Author(s):  
Emer Regina Gates ◽  
Barnaby Hole ◽  
Samantha Hayward ◽  
Nicholas C Chesnaye ◽  
Yvette Meuleman ◽  
...  
Keyword(s):  
Response Rates ◽  
Error Rates ◽  
Symptom Index ◽  
Patient Response ◽  
Advanced Chronic Kidney Disease ◽  
Average Percentage ◽  
Face To Face ◽  
Sf 36 ◽  
The Uk

Abstract BackgroundProspective cohort studies are challenging to deliver, with one of the main difficulties lying in retention of participants. The need to socially distance during the COVID-19 pandemic has added to this challenge. The pre-COVID-19 adaptation of the European Quality (EQUAL) study in the UK to a remote form of follow-up for efficiency provides lessons for those who are considering changing their study design.MethodsThe EQUAL study is an international prospective cohort study of patients ≥65 years of age with advanced chronic kidney disease. Initially, patients were invited to complete a questionnaire (SF-36, Dialysis Symptom Index and Renal Treatment Satisfaction Questionnaire) at research clinics every 3-6 months, known as “traditional follow-up” (TFU). In 2018, all living patients were invited to switch to “efficient follow-up” (EFU), which used an abbreviated questionnaire consisting of SF-12 and Dialysis Symptom Index. These were administered centrally by post. Response rates were calculated using returned questionnaires as a proportion of surviving invitees, and error rates presented as the average percentage of unanswered questions or unclear answers, of total questions in returned questionnaires. Response and error rates were calculated 6-monthly in TFU to allow comparisons with EFU.ResultsOf the 504 patients initially recruited, 236 were still alive at the time of conversion to EFU; 111 of these (47%) consented to the change in follow-up. In those who consented, median TFU was 34 months, ranging from 0 to 42 months. Their response rates fell steadily from 88% (98/111) at month 0 of TFU, to 20% (3/15) at month 42. The response rate for the first EFU questionnaire was 60% (59/99) of those alive from TFU. With this improvement in response rates, the first EFU also lowered errors to baseline levels seen in early follow-up, after having almost trebled throughout traditional follow-up.ConclusionsOverall, this study demonstrates that administration of shorter follow-up questionnaires by post rather than in person does not negatively impact patient response or error rates. These results may be reassuring for researchers who are trying to limit face-to-face contact with patients during the COVID-19 pandemic.

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