ABSTRACT
Background The Covid-19 pandemic has placed healthcare services under significant strain. Royal College of Paediatric & Child Health advised use of virtual consultation where possible. 1 2 Within the published literature there is clear evidence demonstrating the many benefits of telephone consultation including telephone appointments being more convenient, more cost-effective, improved quality of care and decreased non-attendance rates.3 Telephone clinics were implemented in community paediatric services in the southern trust, Northern Ireland during the Covid-19 pandemic. Objectives To understand service users and staff satisfaction of community paediatric phone clinics during the Covid-19 pandemic. Methods The Quality Improvement team completed literature review on similar types of projects. A questionnaire was designed for service users to determine their satisfaction for phone clinics in community paediatrics. A separate questionnaire for (clinicians and administrative) staff was also developed to understand their experience. Feedback was obtained from randomly selected service users over the period of May to October 2020. The questionnaire was sent to service users by post with self-addressed return envelope after the phone clinic. Staff was asked to complete questionnaires for five separate phone clinics encounters during the same six-month period. Results Summary of results from staff questionnaire: Total of 10 staff members were requested to complete the questionnaires and 7 returned. Regarding setting/environment category of the questionnaire, staff reported 100% access to quiet area with a functioning phone as well as availability to PC with Internet connection, and access to patient chart. Conclusions Telephone clinic can be a useful tool to ensure patients receive timely care via a time efficient method. This project demonstrated overall positive experience from service users. However due to small sample of returned questionnaires from service users would be a limitation of this study therefore further similar studies would be beneficial after covid-19 pandemic.
ABSTRACT
General anaesthesia is known to achieve the shortest decision-to-delivery interval for category-1 caesarean section. We investigated whether the COVID-19 pandemic affected the decision-to delivery interval and influenced neonatal outcomes in patients who underwent category-1 caesarean section. Records of 562 patients who underwent emergency caesarean section between 1 April 2019 and 1 July 2019 in seven UK hospitals (pre-COVID-19 group) were compared with 577 emergency caesarean sections performed during the same period during the COVID-19 pandemic (1 April 2020-1 July 2020) (post-COVID-19 group). Primary outcome measures were: decision-to-delivery interval; number of caesarean sections achieving decision-to-delivery interval < 30 min; and a composite of adverse neonatal outcomes (Apgar 5-min score < 7, umbilical arterial pH < 7.10, neonatal intensive care unit admission and stillbirth). The use of general anaesthesia decreased significantly between the pre- and post-COVID-19 groups (risk ratio 0.48 (95%CI 0.37-0.62); p < 0.0001). Compared with the pre-COVID-19 group, the post-COVID-19 group had an increase in median (IQR [range]) decision-to-delivery interval (26 (18-32 [4-124]) min vs. 27 (20-33 [3-102]) min; p = 0.043) and a decrease in the number of caesarean sections meeting the decision-to-delivery interval target of < 30 min (374/562 (66.5%) vs. 349/577 (60.5%); p = 0.02). The incidence of adverse neonatal outcomes was similar in the pre- and post-COVID-19 groups (140/568 (24.6%) vs. 140/583 (24.0%), respectively; p = 0.85). The small increase in decision-to-delivery interval observed during the COVID-19 pandemic did not adversely affect neonatal outcomes.