How to Conduct a Telephone Consultation; an Informative Guide

Dental Update ◽  
2020 ◽  
Vol 47 (7) ◽  
pp. 594-599 ◽  
Author(s):  
Deirdre Coffey ◽  
Anne Begley
Keyword(s):  
Clinical Care ◽  
Information Gathering ◽  
Formal Training ◽  
Time Cost ◽  
Remote Diagnosis ◽  
Telephone Consultation ◽  
Educational Framework ◽  
Specific Setting ◽  
Key Steps ◽  
Remote Consultations

Telemedicine is the remote diagnosis and treatment of patients by means of telecommunications technology. The advantages of telemedicine include reduced travel time/cost and enhanced access to healthcare. The coronavirus pandemic in 2020 has necessitated the rapid implementation of remote consultations across all healthcare platforms, in most cases without any formal training. We present an educational framework for conducting telephone consultations in secondary care to help fill this gap. There are five key steps in a telephone consultation; patient introduction, information gathering, establishing a working diagnosis and plan for clinical care, planning the next step and closing the consultation. By focusing on what each step entails, this paper aims to help those new to telemedicine techniques and those responsible for training them, to shorten the learning curve. CPD/Clinical Relevance: This article aims to help clinicians become proficient and comfortable in conducting telephone consultations by providing a structure to the consultation which they can customize to their specific setting.

scholarly journals AB0903-HPR DURATION OF TELEPHONE CONSULTATIONS AMONGST RHEUMATOLOGY PRACTITIONERS IN A DISTRICT GENERAL HOSPITAL - ADAPTING TO REMOTE CONSULTATION IN A COVID-19 PANDEMIC

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1474.1-1474
Author(s):  
L. Parker ◽  
F. Coldstream
Keyword(s):  
General Hospital ◽  
Controlled Trial ◽  
Clinical Care ◽  
District General Hospital ◽  
British Society ◽  
Nice Guideline ◽  
Face To Face ◽  
Co Morbidity ◽  
Randomised Controlled ◽  
Remote Consultations

Background:The Covid-19 pandemic has resulted in a rapid adoption of remote consultations in order to limit face to face clinical contact wherever appropriate, as recommended by the British Society for Rheumatology. The same clinic templates which existed for face-to-face encounters have been retrospectively adapted, without consideration of any potential difference in duration of consultations. Rheumatology practitioners from a variety of clinical backgrounds work alongside the rheumatology consultants, providing clinical care to patients with both inflammatory arthritis and connective tissue disease.Objectives:To record the duration of all scheduled telephone consultations carried out by advances rheumatology practitioners in a 4-week period.Methods:All scheduled telephone clinic encounters over a 4-week period were timed and the duration recorded in a spreadsheet. Data was collected in real time by all 8 rheumatology advanced practitioners working within the rheumatology department of a district general hospital, following each clinic episode.Results:Data was recorded from a total of 337 clinic appointments. Of these, 317 (94%) were booked as routine, 3 (0.9%) as urgent, 4 (1.2%) were expedited following an advice line contact, and 13 (3.9%) no data was recorded. 28 (8%) of the patients did not answer when contacted. 80 (24%) clinic appointments lasted 15 minutes or less, 186 (55%) lasted 16 - 30 minutes, 37 (11%) lasted 31 - 45 minutes, and 6 (2%) lasted 46 - 60 minutes. The average duration was 22 minutes.Conclusion:Within this department, remote consultations appear to have a similar duration when compared against the traditional clinic template for a fully face-to-face clinic, with some encounters lasting significantly longer than the planned duration. This would appear to differ to telephone consultations used in other settings, such as general practice where the duration is reportedly shorter1. This may be representative of the additional complexity and co-morbidity of a typical rheumatology patient, or due to the multi-faceted nature of a rheumatology follow-up appointment2. Although remote consultations are effective in limiting risk of exposure to Covid-19, they may not offer a quicker or more efficient service compared with the face-to-face model. Further study in this field is required to evaluate this widely adopted new pattern of working.References:[1]Pinnock H, Bawden R, Proctor S, Wolfe S, Scullion J, Price D, Sheikh A. Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial. BMJ. 2003 Mar 1;326(7387):477-9. doi: 10.1136/bmj.326.7387.477. PMID: 12609944; PMCID: PMC150181.[2]National Institute for Health and Care Excellence (NICE) (2018) rheumatoid arthritis in adults: management (NICE Guideline NG100). Available at https://www.nice.org.uk/guidance/ng100 [Accessed 05 January 2021].Disclosure of Interests:None declared

scholarly journals How to do (or not to do) … using the standardized patient method to measure clinical quality of care in LMIC health facilities

2019 ◽  
Vol 34 (8) ◽  
pp. 625-634 ◽  
Author(s):  
Jessica J C King ◽  
Jishnu Das ◽  
Ada Kwan ◽  
Benjamin Daniels ◽  
Timothy Powell-Jackson ◽  
...  
Keyword(s):  
Clinical Care ◽  
Healthcare Providers ◽  
Sampling Strategy ◽  
Ethical Challenges ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Rich Data ◽  
Mystery Shoppers ◽  
Key Steps

Abstract Standardized patients (SPs), i.e. mystery shoppers for healthcare providers, are increasingly used as a tool to measure quality of clinical care, particularly in low- and middle-income countries where medical record abstraction is unlikely to be feasible. The SP method allows care to be observed without the provider’s knowledge, removing concerns about the Hawthorne effect, and means that providers can be directly compared against each other. However, their undercover nature means that there are methodological and ethical challenges beyond those found in normal fieldwork. We draw on a systematic review and our own experience of implementing such studies to discuss six key steps in designing and executing SP studies in healthcare facilities, which are more complex than those in retail settings. Researchers must carefully choose the symptoms or conditions the SPs will present in order to minimize potential harm to fieldworkers, reduce the risk of detection and ensure that there is a meaningful measure of clinical care. They must carefully define the types of outcomes to be documented, develop the study scripts and questionnaires, and adopt an appropriate sampling strategy. Particular attention is required to ethical considerations and to assessing detection by providers. Such studies require thorough planning, piloting and training, and a dedicated and engaged field team. With sufficient effort, SP studies can provide uniquely rich data, giving insights into how care is provided which is of great value to both researchers and policymakers.

Museums behind the Gallery Doors

PMLA ◽  
2010 ◽  
Vol 125 (1) ◽  
pp. 129-133
Author(s):  
Robert D. Aguirre
Keyword(s):  
Nineteenth Century ◽  
Formal Training ◽  
Critical Practice ◽  
Scholarly Literature ◽  
Critical Studies ◽  
Informal Empire ◽  
The World ◽  
Museum Exhibitions ◽  
History Of ◽  
Key Steps

I am often asked how a Victorianist came to write a book about museum exhibitions and the British quest for and Traffic in pre-Columbian antiquities. When I began, I had no formal training in these subjects and thus little that would count as a theory or method. Of course, as my interest grew I read as much of the scholarly literature as I could: critical studies of important collectors; analyses of exhibitionary practice and museum administration; the history of the museum from cabinets of curiosity to the virtual collections of the present. Yet much of what I learned in writing my own book, Informal Empire, was pieced together, often haltingly, one fragment at a time through a deep immersion in a rich archive. Sensing I was on new ground, I rejected any overarching schema, adhering to the perhaps counterintuitive notion that the best way to make the archive speak was to resist imposing a theory on it and instead to allow the shape of the materials themselves to suggest ways of proceeding. To illustrate both the advantages and the liabilities of this method, which I employed while working on nineteenth-century ethnography collections, I have chosen here to reconstruct the key steps of the scholarly journey that took me from the library to the world of museums and archives. I offer this reflection on critical practice first as an exercise in demystification and second as an encouragement to anyone, but especially students, who might wish to travel similar paths.

Reflections on how to approach early career psychiatrist roles and challenges

2021 ◽  
pp. 103985622110108
Author(s):  
Jeffrey C L Looi ◽  
Angus J F Finlay ◽  
Daniel S Heard
Keyword(s):  
Reflective Practice ◽  
Clinical Supervision ◽  
Clinical Care ◽  
Early Career ◽  
Formal Training ◽  
Common Elements ◽  
Public And Private ◽  
Informal Mentoring ◽  
Direct Guidance ◽  
Clinical Directors

Objective: To reflect upon and provide experiential advice to address the roles of early career psychiatrists. The main roles include leading patient care; working in teams; clinical supervision and governance of trainees, and of the psychiatrist by clinical directors/managers. While these roles vary across public and private sectors, the discussion focuses on common elements. Conclusions: The first several years of an early career psychiatrist’s work often involves roles for which formal training cannot provide direct guidance, and which benefit from planning and reflective practice. Learning how to navigate clinical care, clinical supervision and governance, formal/informal mentoring and peer review are necessary to effective practice.

scholarly journals Patients’ Experiences of Remote Neurology Consultations during the COVID-19 Pandemic

2020 ◽  
pp. 1-4
Author(s):  
Mary Clare McKenna ◽  
Mahmood Al-Hinai ◽  
David Bradley ◽  
Elisabeth Doran ◽  
Isabelle Hunt ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Continuity Of Care ◽  
Chronic Illnesses ◽  
Telephone Consultation ◽  
General Neurology ◽  
Face To Face ◽  
Global Pandemic ◽  
Neurology Clinic ◽  
The Mean ◽  
Remote Consultations

Telemedicine has been widely implemented during the COVID-19 global pandemic to enable continuity of care of chronic illnesses. We modified our general neurology clinic to be conducted using remote audio-only telephone consultations. We included all patients over a 10-week period who agreed to both a telephone consultation and a questionnaire afterwards in order to ascertain the patient’s perspective of the experience. There were 212 participants consisting of men (43.8%) and women (56.2%). The mean ± standard deviation of age was 47.8 ± 17.0 (range 17–93) years. For the most part, patients found remote consultations either “just as good” (67.1%) or “better” (9.0%) than face-to-face consultations. Those who deemed it to be “not as good” were significantly older (52.3 ± 17.9 years vs. 46.6 ± 16.6 years, <i>p =</i>0.045) or were more likely to have a neurological disorder that required clinical examination, namely, a neuromuscular condition (66.7%, <i>p =</i> 0.002) or an undiagnosed condition (46.7%, <i>p =</i> 0.031). At the height of the COVID-19 global pandemic, most patients were satisfied with remote consultations. The positive feedback for remote consultations needs to be verified outside of this unique scenario because the results were likely influenced by the patients’ apprehension to attend the hospital amongst other factors.

scholarly journals P068 Early experience and outcomes of telephone and video consultations in rheumatology during first wave of COVID-19

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Chandini Rao ◽  
Sarah Horton ◽  
Elizabeth MacPhie ◽  
Ayesha Madan ◽  
Sarah Fish
Keyword(s):  
Final Diagnosis ◽  
Patient Survey ◽  
Initial Assessment ◽  
Management Decision ◽  
Outpatient Services ◽  
Telephone Consultation ◽  
North West ◽  
Inflammatory Conditions ◽  
Video Consultation ◽  
Remote Consultations

Abstract Background/Aims  The 2018 NHS Long Term Plan set a target of reducing face to face (F2F) outpatient visits by a third within 5 years. The COVID-19 pandemic forced departments to implement changes to the delivery of outpatient services at unprecedented speed. Here we present our community-based department’s experience of offering telephone and video consultations to new patients during the first wave of the pandemic. Methods  All new patients (excluding those with suspected early inflammatory arthritis or other conditions triaged as urgent) offered an appointment with a consultant or extended scope physiotherapist in the rheumatology service from 11 May 2020 were offered a choice of a telephone or video consultation. Data were collected on the choice of appointment, provisional diagnosis, final diagnosis and need for a subsequent F2F assessment. Surveys to assess patient and staff experience were distributed and analysed. Results  Between 11/05/2020 and 24/07/2020, 215 virtual consultations were booked. 124 patients (57.7%) opted for a video consultation and 91 (42.3%) chose a telephone consultation. The 'Did Not Attend' rate was 5.1%. Following the initial assessment, 68% of patients were discharged, 16% were booked for a F2F appointment and 16% required further investigations prior to a management decision. The discharge rates between video (70%) and telephone (65%) consultations were similar. Patients with non-inflammatory conditions such as fibromyalgia, hypermobility and osteoarthritis were more likely to be discharged after a virtual consultation. The staff survey highlighted that most clinicians had no prior experience or training in conducting virtual consultations. However, confidence in these modalities rapidly grew, with the majority of respondents happy to deliver a varying proportion of consultations remotely post pandemic. The first 20 patient surveys returned showed that remote consultations were generally well received. 16 patients (80%) agreed or strongly agreed that the consultation met their needs and was a suitable replacement for a F2F appointment. However, only 60% stated that they would be happy to have remote appointment after the pandemic. Conclusion  Telephone and video consultations for rheumatology new patients were successfully adopted during the first wave of the COVID-19 pandemic, particularly for non-inflammatory conditions. Although clinicians had limited experience and training in remote consultations prior to the crisis, most adapted rapidly and would consider continuing with them after the pandemic. The majority of patients were happy with their virtual consultation during the first wave, although were less certain of their acceptability in the future. A further analysis and patient survey is underway to ascertain any differences during the second wave. We propose a hybrid model in the post-pandemic future to offer patients a choice of F2F, telephone or video consultations. Disclosure  C. Rao: None. S. Horton: None. E. MacPhie: Other; EM is the secretary of the North West Rheumatology Club, whose regional meetings have been funded by an unrestricted educational grant from UCB and are now sponsored by Abbvie. A. Madan: None. S. Fish: Other; Member of the Heberden Committee.

The Clinical Use of Antipsychotic Plasma Levels

2021 ◽  
Author(s):  
Jonathan M. Meyer ◽  
Stephen M. Stahl
Keyword(s):  
Mental Health Professionals ◽  
Nurse Practitioners ◽  
New Technologies ◽  
Clinical Care ◽  
Formal Training ◽  
Accessible Information ◽  
Clear Explanation ◽  
Oral Antipsychotic ◽  
Essential Resource ◽  
Trough Levels

Clinicians recognize that monitoring psychotropic levels provides invaluable information to optimize therapy and track treatment adherence, but they lack formal training specifically focused on the use of plasma antipsychotic levels for these purposes. As new technologies emerge to rapidly provide these results, the opportunity to integrate this information into clinical care will grow. This practical handbook clarifies confusing concepts in the literature on use of antipsychotic levels, providing clear explanations for the logic underlying clinically relevant concepts such as the therapeutic threshold and the point of futility, and how these apply to individual antipsychotics. It offers accessible information on the expected correlation between dosages and trough levels, and also provides a clear explanation of how to use antipsychotic levels for monitoring oral antipsychotic adherence, and methods to help clinicians differentiate between poor adherence and variations in drug metabolism. An essential resource for psychiatrists, psychiatric nurse practitioners, and mental health professionals worldwide.

scholarly journals The Cognitive Process of Wildland Fire Chainsaw Troubleshooting: Structure, Content, and Training

2019 ◽  
Vol 63 (1) ◽  
pp. 1676-1680
Author(s):  
Elliot Nauert ◽  
Doug Gillan
Keyword(s):  
Cognitive Process ◽  
Wildland Fire ◽  
Cognitive Task ◽  
Formal Training ◽  
Analysis Method ◽  
Job Aids ◽  
Wildland Firefighting ◽  
Key Steps ◽  
Formal Training Program ◽  
And Training

Wildland firefighting often involves the creation of a fireline (a break in vegetative fuels), an operation commonly hindered by the break-down of gas-powered chainsaws. Some firefighters may not possess the knowledge and skills needed to address break-downs quickly, which threatens productivity and safety. The Applied Cognitive Task Analysis method was used to examine the troubleshooting process of an expert wildland fire sawyer. This included elicitations of key steps in this process, specific pieces of valuable knowledge, and sources of expertise. These results show that much of the expert understanding of complex faults was developed on-the-job rather than during a formal training program. This study highlights areas where training and job aids may be improved to support wildland firefighters in chainsaw troubleshooting and provides preliminary support of ACTA as a tool for training specialists in this domain.

scholarly journals 1599 Review of Telephone Consultations for Suspected Head and Neck Cancer Referrals During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Suresh ◽  
A Goel ◽  
N Khan ◽  
P Promod ◽  
R Pabla ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Patient Choice ◽  
Electronic Records ◽  
Continuing Care ◽  
Delivery Of Healthcare ◽  
Telephone Consultation ◽  
Face To Face ◽  
Remote Consultations

Abstract Introduction Pandemic COVID-19 necessitated a transformation in the delivery of healthcare. Telephone consultations were introduced to protect and progressively manage patients with minimal delay. This is a review of the effectiveness of these remote consultations for suspected 2-week wait (2ww) head and neck cancer referrals to a north London NHS teaching hospital Oral and Maxillofacial unit during the first official UK government lockdown from March - July 2020. Method Prospective electronic records of 176 consecutive 2ww referrals between March – July 2020 was assessed. Data analysed included initial telephone consultations, subsequent face-to-face (F2F) appointments, if required, the interval from telephone to F2F appointments and histopathological diagnoses. Results 157 patients (n = 176) received an initial telephone call, of which 127 (80.9%) required a F2F consultation. The number of days between the initial telephone consultation and subsequent F2F assessment ranged from 0 to 141, with a mean of 11 and a median of 1. Notably, 31 patients (24.4%) were seen in person on the same day as their telephone consultation. Biopsies were indicated for 69 patients (54.3%) of which 9 (13.0%) were diagnosed as malignancies. Conclusions Whilst protecting patients from a pandemic is utmost, continuing care for non-pandemic conditions must be considered. It is even more important to manage 2ww referrals efficiently. These results indicate the majority of suspected cancer referrals warrant F2F assessment for a confident outcome. Despite reinstated, ongoing social restrictions, 2ww referrals are now being seen exclusively F2F, subject to patient choice. This information is useful for planning and strategizing services in a head and neck OMFS unit.

scholarly journals COVID-19 and myositis – unique challenges for patients

Rheumatology ◽  
2020 ◽  
Author(s):  
Latika Gupta ◽  
James B Lilleker ◽  
Vikas Agarwal ◽  
Hector Chinoy ◽  
Rohit Aggarwal
Keyword(s):  
Medical Care ◽  
Detrimental Effect ◽  
Clinical Care ◽  
Autoimmune Conditions ◽  
Health Related ◽  
Reported Health ◽  
Experienced Difficulty ◽  
Remote Consultations ◽  
Do So

Abstract Objective The COVID-19 pandemic and the subsequent effects on healthcare systems is having a significant effect on the management of long-term autoimmune conditions. The aim of this study was to assess the problems faced by patients with idiopathic inflammatory myopathies (IIM). Methods An anonymized eSurvey was carried out with a focus on effects on disease control, continuity of medical care, drug procurance and prevalent fears in the patient population. Results Of the 608 participants (81.1% female, median (s.d.) age 57  (13.9) years), dermatomyositis was the most frequent subtype (247, 40.6%). Patients reported health-related problems attributable to the COVID-19 pandemic (n = 195, 32.1%); specifically 102 (52.3%) required increase in medicines, and 35 (18%) required hospitalization for disease-related complications. Over half (52.7%) of the surveyed patients were receiving glucocorticoids and/or had underlying cardiovascular risk factors (53.8%), placing them at higher risk for severe COVID-19. Almost one in four patients faced hurdles in procuring medicines. Physiotherapy, critical in the management of IIM, was disrupted in 214 (35.2%). One quarter (159, 26.1%) experienced difficulty in contacting their specialist, and 30 (4.9%) were unable to do so. Most (69.6%) were supportive of the increased use of remote consultations to maintain continuity of medical care during the pandemic. Conclusion This large descriptive study suggests that the COVID-19 pandemic has incurred a detrimental effect on continuity of medical care for many patients with IIM. There is concern that delays and omissions in clinical care may potentially translate to poorer outcomes in the future.

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