ABSTRACT
Introduction The COVID-19 pandemic has forced healthcare professionals (HCPs) to rapidly alter their delivery of outpatient services. Perceived benefits include reducing unnecessary travel and waiting times. However, as one of the geographically largest training regions in the UK, we aimed to determine satisfaction levels amongst gastroenterology HCPs with the 'new normal'. Methods Satisfaction surveys were disseminated electronically across 13 acute trusts in the South West between June and August 2021. These consisted of multiple choice questions and Likert 5-scale ranking questions, ranging from 'strongly agree' to 'strongly disagree'. Virtual clinics were defined as telephone or video consultations. Results 64 HCPs from 7 trusts responded (52% consultants;23% registrars;19% nurse specialists;6% dieticians). 80% had performed phone consultations and 23% were providing video consultations. 94% of participants stated face-to-face (F2F) consultations remained their preferred mode of clinic, whilst video consultation was the least favoured for new patients. For follow-up patients, the most favoured combination was phone and F2F consultations, followed by solely F2F consultations. Less than a third of respondents strongly agreed that they would be comfortable using a computer for video consultation (32%), compared to over half when using phone instead (53%). 47% of HCPs stated virtual clinics were now the default clinic mode in their trust. The majority of respondents found it difficult to develop a rapport with remote consultations, with only 19% respondents stating this was not an issue. There was equipoise about whether time efficiency improved with virtual consultations, though 60% of respondents agreed or strongly agreed that virtually delivered clinics can reduce clinic non-attendance. Two thirds of respondents did not have a local process to identify patients who would not benefit from virtual clinics, whilst over three quarters did not have technical support to troubleshoot issues during virtual clinics (78%). Only five respondents (8%) thought it was straightforward to include an interpreter on a virtual consultation and 70.3% had difficulties including relatives on virtual calls. Conclusions Gastroenterology departments in the South West continue to adapt to delivery of virtual clinics, through a predominantly telephone format. There is consensus that followup patients do not routinely need to F2F appointments, but new patients should primarily be seen F2F. Departments should have clear protocols to identify patients that will not benefit from virtual consultations. Finally, robust strategies are required to accommodate patients whose first language is not English to ensure they are not disproportionately disadvantaged.
ABSTRACT
Introduction The COVID-19 pandemic has forced patients to rapidly adjust to virtual consultations in outpatients. A perceived benefit is reducing unnecessary travel. However, there is a paucity of literature describing acceptability of virtual consultations to gastroenterology patients. Methods In collaboration with the Patient Experience team, satisfaction surveys were disseminated in Gastroenterology and Hepatology clinics at Bristol Royal Infirmary electronically via SurveyMonkey® and paper format between June and August 2021. These consisted of multiple choice questions and Likert 5-scale ranking questions, ranging from 'strongly agree' to 'strongly disagree'. Virtual clinics were defined as telephone or video consultations. Data was collected on patient demographic, travel method, satisfaction with virtual clinics, and preferences for service delivery. Results 100 patients completed the survey (27% aged 55- 64yrs;21% aged 65-74 years). 50%, 27% and 23% of patients were from hepatology clinic, inflammatory bowel disease clinic and general gastroenterology clinic respectively. 84% were follow-up patients. 56% of patients normally drove to appointments, with a further 30% taking public transport. 23% of patients were travelling over 10 miles to attend appointments. 38% of patients were in full-time employment of which 63.1% had to take annual leave to attend appointments (n=24/38). 82% of patients owned a laptop of which 19.5% (n=16/82) disagreed or strongly disagreed with feeling comfortable using their computer for an online appointment. Face-to-face (F2F) consultation was the preferred mode of appointments in almost half of patients (49%), followed by a mix of F2F and telephone consultations (19%). 54% of patients agreed or strongly agreed that clinicians could address their concerns virtually, with only 16% disagreeing or strongly disagreeing with this. 65% of patients agreed or strongly agreed they felt comfortable sharing personal information during a virtual consultation, with 14% of patients disagreeing or strongly disagreeing with this. 80% of patients stated they would want to receive bad news in a F2F consultations. Conclusions Virtual consultations appear to be acceptable rather than preferable to gastroenterology patients. F2F consultations remain the overall preference, particularly when receiving bad news. Virtual consultations can provide flexibility in service delivery. This is important given almost two thirds of patients in full time employment had to take annual leave to attend an appointment. Furthermore, as services consider their carbon footprint, with half of patients driving to their appointments in Bristol, virtual consultations offer a genuine opportunity to provide a greener service.
ABSTRACT
IntroductionSingle operator cholangioscopy (SOC) has an important role in the diagnosis and management of biliary strictures and complex biliary stones. The evidence base is evolving, but with small numbers in reported studies. The majority of published literature discusses SOC under general anaesthetic;typically propofol. We compared successful stone clearance, stricture assessment and safety under conscious sedation and propofol.MethodsA single centre retrospective analysis was performed of consecutive SOCs over 8 years at Bristol Royal Infirmary (tertiary referral centre for SW England and South Wales). Parameters included sedation/propofol usage, stone clearance, electrohydraulic lithotripsy (EHL), histology, final diagnosis and complications.ResultsBetween Jan 2013 – Nov 2020, 471 SOCs were performed on 352 patients (175f, 177m);mean age 65.7years (17-92), referred from 18 centres. 15 SOCs were performed in 2013 compared to 99 in 2019 before restrictions from the COVID19 pandemic.228 therapeutic SOCs + EHL were performed for stone clearance, 79.8% (n=182/228) under conscious sedation (median fentanyl dose 150mcg;midazolam 7mg;comfort score 2). Complete stone clearance rose from 79.7% in the conscious sedation group to 89.2% in with propofol sedation, although the difference was not significant (p=0.19).243 diagnostic SOCs were performed, 88.9% under conscious sedation. Similar to therapeutic SOCs, median fentanyl dose 150mcg;midazolam 7mg;and comfort score 2. Overall macroscopic assessment of strictures correlating with malignancy had a sensitivity, specificity and diagnostic accuracy of 90.2% (95%CI 82.7-95.2), 92.6% (95%CI 86.3-96.5) and 91.5% (87.0-94.8%) respectively. Diagnostic accuracy with macroscopic assessment was comparable between patients receiving conscious sedation (91.4%;95%CI 86.6-94.9) vs propofol sedation (92%;95%CI 74.0-99.0). Diagnostic accuracy with histological assessment appeared greater in patients receiving propofol sedation (95%;95%CI 75.1-99.9) compared to conscious sedation (84.7%;95%CI 78.5-89.6)28 adverse events were recorded (5.9%), with post ERCP cholangitis (2.3%) and pancreatitis (2.1%) the commonest causes. Complications were marginally higher in patients receiving propofol sedation (6.8%;n=5/73) vs those receiving conscious sedation (5.8%;n=23/398) but the difference was not significant (p=0.72).ConclusionsThis is the largest single centre retrospective analysis of SOCs. Successful stone clearance is similar to results found in literature from smaller studies. There was a trend to greater successful stone clearance with propofol. Conscious sedation has previously been described as a risk factor for inadequate visualisation, but we found very similar high levels of diagnostic accuracy in both groups. Both were generally well tolerated with low rates of adverse events.