Do Telephone Clinics Lead to Greater Patient Satisfaction in General Surgical Outpatients?

Aims: To limit exposure risk in view of The current COVID-19 pandemic, telephone clinics have become The mainstay of outpatient assessment. Although there is data from primary care, there is little evidence for The suitability of telemedicine within General Surgery. The lack of clinical examination can be dissatisfying for both patient and surgeon. The aim of this study was to explore patient satisfaction from telephone clinics in a General Surgery setting. Method(s): Data was collected prospectively from General Surgery clinic appointments by a single surgeon in a District General Hospital from September 2021. Demographic data was obtained in addition to a short questionnaire at The end of their consultation. Patients were asked to score their experience out of 5 (5 being most favourable) and their preference in Comparison to face to face appointments. Result(s): 156 patients were included in The study, of which 95% of patients were contactable. 98% of patients gave The experience a satisfaction score of 3 or more out of 5. The median satisfaction score was 5. 97% expressed a preference over a Face-to-Face appointment. 7% of patients required a further Face-to-Face consultation and this group were more likely to have a lower patient satisfaction score. Conclusion(s): Telephone clinics within General Surgery achieve excellent satisfaction for The majority of patients. The patient experience could be further optimised by careful selection of patient suitability for The service. The data provides supportive evidence to The NHS Long Term Plan to reduce Face-to Face outpatient appointments by one third before 2024.

Financial implications of gallstone-related complications whilst awaiting elective cholecystectomy: A single institution experience of 900 patients

Aims: Over 65,000 cholecystectomies are performed each year in The United Kingdom with increasing waiting-list times due to The CoVID-19 pandemic. This study set out to understand The cost to The NHS of complications experienced whilst awaiting cholecystectomy. Method(s): A retrospective cohort study was carried out for all patients who had been awaiting elective cholecystectomy for more than 20 weeks On The 17th September 2021 at a large NHS Foundation Trust. Demographic data was collected at The time of listing. Re-admission data was collected from patient notes. It included clinical history, blood results and imaging investigations. Associated costs were calculated. Result(s): 900 patients included in The study (median age 56 years, 71.7% female). 138 patients (15.3%) re-presented to hospital whilst On The waiting list with complications of gallstone disease. Of these, 51 had more than one presentation to hospital with 18 patients having more than three presentations. This was equivalent to 625 days in hospital, with only 79 same day discharges, and multiple investigations were performed (ultrasound scan = 79;CT scan = 31, MRCp = 47, ERCp = 21). This was estimated to have cost a minimum of 364,917. Assuming an average time for an elective cholecystectomy of 90 mins at a cost of 1,200 per hour, 202 additional cholecystectomies could have been performed. Conclusion(s): This study highlights The enormous potential to reduce patient suffering by increasing The number of elective cholecystectomy lists, and at no overall additional cost to The trust.

Can self-estimated BMI be used for pre-operative planning in elective General surgery?

Aims: Telemedicine is being increasingly used in outpatient settings following The COVID-19 pandemic. This study aimed to determine if self-estimated body mass index (BMI), from telephone consultation, was accurate and useful for planning prior to elective General surgery. Method(s): Age, gender and estimated BMI were collected from consecutive patients attending a pre-operative telephone clinic under a single surgeon at a district General hospital in The South of England between April and October 2021. Actual BMI was measured on The day of Surgery and compared. Result(s): 124 patients were included (median age 59 years, 49.2% male). BMI was accurately estimated by 38, under-estimated by 33 and over-estimated by 53 participants. Overall, there was a significant difference in The pre-operative and post-operative BMI (P = 0.003). This was significant for females (median change 0.1, IQR 0.0-0.7, P = 0.002) but not for males (median change 0.0, IQR-0.1, 0.2, P = 0.479). Those with an actual BMI >29.9 had a significantly higher median change (0.2 (0.0, 1.1) compared to those with BMI <29.9 (0.0 (-0.2, 0.1);P <0.001). only 2 patients could have required a change in surgeon on The day of The procedure (P = 0.500). Conclusion(s): Self-estimated BMI is a suitable method for assessing patients for planning in elective General surgical procedures, particularly for males. However, it is important to be aware of those with higher BMIs, particularly females, who may underestimate their BMI.