ABSTRACT
Background and Aim: The rapid spread of coronavirus disease 2019 (COVID-19) warranted a change in service delivery in our tertiary hospital from face-to-face contact at outpatient clinics to predominantly telephone and video consultations. The constraints of remote consultations on clinical examination and reduced access for patients to pathology and radiology present challenges in patient care. We aimed to measure the impact of telephone and video consultations on patient care and clinic efficiency. Methods: Face-to-face outpatient clinic appointments were converted to telephone or video consultations from March 2020. Patient events were taken from our general hepatology and viral hepatitis clinics, comparing a 4-week period in May 2020 to May 2019. Hospital electronic health records (BOSSnet;Core Medical Solutions), pathology (iSOFT;DXC Technology), and radiology (IMPAX;Agfa HealthCare) databases were used to record the following outcomes: mode of service delivery;did-not-attend (DNA) or patient uncontactable rate;absence of required pathology or radiology results;and follow-up outcomes, including standard follow-up, general practitioner, chart review in clinic, results review out of clinic time, and early clinic follow-up. Events with inadequate documentation were excluded from the study. Episodes of care where the clinician detailed that clinical decisions could not be made or were delayed due to the nature of the consultation were recorded. Fisher's exact test was used to compare the years, with P < 0.05 used for significance. Results: We reviewed a total of 267 and 306 clinic appointments in 2019 and 2020, respectively, over the 4-week period each May. After excluding patients with no documentation, there remained 249 patients in 2019 and 284 patients in 2020. The mean age of patients was 55 years in both year groups, with male patients making up 53.5% of patients in 2019 and 50.6% in 2020. As per the change in hospital policy for management of COVID-19, most appointments in 2020 were conducted virtually, with only 3.3% of patients seen face to face. This is in contrast to 2019, when virtual consultations were the minority (Table 1). Compared with 2019, the DNA rate was significantly higher in 2020 (18.89% vs 25.35%;P = 0.017). There was no significant difference in the rate of patients who came to clinic without having had the required investigations (26.0% in 2019 vs 31.1% in 2020;P = 0.32). A significantly larger number of patients required earlier clinic follow-up in 2020 (5% in 2019 vs 13.1% in 2020;P = 0.01). In 20.4% of consultations in 2020, clinical decisions were delayed as determined by the treating clinician. This is in contrast to 2019, when there were only 2% of patients who had clinical care delayed (P < 0.001). Conclusion: Virtual consultations over telephone and video call are convenient for patients. In 2020, there was a higher rate of DNAs and a greater proportion of patients who did not have the required investigations to allow further patient management. These factors lead to delays in clinical care and inefficient service delivery due to the requirement for results to be followed up outside of clinic time. A greater number of clinic appointments are required to achieve similar progression in patient management, due to clinical need for examination or face-to-face discussion. Virtual clinics are potentially useful in maintaining a limited level of patient contact during the COVID-19 pandemic. However, this study raises concerns about patient care and system efficiencies if remote care is provided long term. Further studies are required to identify specific patient cohorts who may be more suited to a remote style of clinic review.