ABSTRACT
1529 Table 1Inclusion and exclusion criteriaInclusion criteria · Clinics taken place in the paediatric Rainforest outpatient department at Peterborough City Hospital · Children aged from 6 to 16 years Exclusion criteria · Children younger than 5 years · All face-to-face clinics. · Physiotherapy, dietician and psychological clinics · Oncology medicine clinics ResultsA total of 690 letters were reviewed that met the inclusion criteria. 182 (26.37%) were video consultations and 508 (73.76%) were telephone consultations [figure 1]. The male: female ratio was almost equal to 1.09:1.Of the 690 consultations, in 278 (40.27%) children were present, in 37 (5.36%) the children were at school and in 375 (54.34%), the majority, it was not documented about the presence of the child or any discussion with them [figure 2].In those consultations in which children were present, 123 (44.24%) were video consultations and 155 (55.75%) were telephone consultations [figure 3].Of the 182 total video consultations, in123 (67.58%) consultations children were present. On the other hand, of the 508 telephone consultations, only 155 (30.5%) had children present during the consultation [figure 4].ConclusionsRemote consultations are not without drawbacks. A specific setting is required for a good remote consultation. This can lead to diagnostic difficulty or ambiguity and one should be more vigilant for safeguarding issues. In telephone consultations, there is a lack of inspection or visual assessment. In our study, we found that in more than half of the consultations, there was no clear documentation about the presence of the child or about the involvement of the child during paediatric remote clinics. This is an important missing element of the consultation that may further compound the issues described.The use of remote consultations will need careful planning, audit and standardized guidance from societies and royal colleges depending on the type of paediatric service, age of the patient, clinical subspecialty and new vs. follow up clinics to ensure a safe service.
ABSTRACT
BACKGROUND: COVID-19 has impacted on healthcare provision. Anecdotally, investigations for children with inflammatory bowel disease (IBD) have been restricted, resulting in diagnosis with no histological confirmation and potential secondary morbidity. In this study, we detail practice across the UK to assess impact on services and document the impact of the pandemic. METHODS: For the month of April 2020, 20 tertiary paediatric IBD centres were invited to contribute data detailing: (1) diagnosis/management of suspected new patients with IBD; (2) facilities available; (3) ongoing management of IBD; and (4) direct impact of COVID-19 on patients with IBD. RESULTS: All centres contributed. Two centres retained routine endoscopy, with three unable to perform even urgent IBD endoscopy. 122 patients were diagnosed with IBD, and 53.3% (n=65) were presumed diagnoses and had not undergone endoscopy with histological confirmation. The most common induction was exclusive enteral nutrition (44.6%). No patients with a presumed rather than confirmed diagnosis were started on anti-tumour necrosis factor (TNF) therapy.Most IBD follow-up appointments were able to occur using phone/webcam or face to face. No biologics/immunomodulators were stopped. All centres were able to continue IBD surgery if required, with 14 procedures occurring across seven centres. CONCLUSIONS: Diagnostic IBD practice has been hugely impacted by COVID-19, with >50% of new diagnoses not having endoscopy. To date, therapy and review of known paediatric patients with IBD has continued. Planning and resourcing for recovery is crucial to minimise continued secondary morbidity.