ABSTRACT
Content: The COVID-19 pandemic has mandated rapid adoption of a new approach to outpatient appointments for our Haematology patients, the majority of whom are classed as vulnerable and have been required to isolate for prolonged periods following government guidelines. Within a short space of time remote consultation by telephone replaced the traditional face-to-face outpatient consultation for the majority of our patients. There has been appetite in other departments locally and regionally to consider implementation of video consultation as a replacement for telephone consultation and we were asked as a department to consider implementation to enhance patient experience. We were concerned that adoption of video consultation would create barriers for some, and questioned whether our patients would perceive a benefit of video, compared to telephone consultation. We identified and contacted by telephone 36 consecutive patients who had participated in a general haematology telephone consultation during the final two weeks of June 2020. We designed a survey to assess patient satisfaction of the telephone consultation;access to hardware necessary to participate in video consultation;relevant experience of using video calling / conferencing and their preference when offered further remote consultations. Of the 29 patients who consented to be surveyed, 28 were satisfied with the process and quality of their telephone consultation (97%). We found that 6 patients (21%) did not have access to necessary hardware to participate in video consultation and although the rest had the hardware to participate;only 15 patients (52%) had any prior experience of using video calling / conferencing and would feel confident to use similar software. We asked our patients about their level of preference for video consultation in the future. We found that only 5 patients (17%) would prefer to have a video consultation, with the level of preference falling further to only 2 patients (7%) should the software required to participate not be available to install remotely on a home device. Our results show that our patients have a high level of satisfaction using the telephone as a method of remote consultation. We demonstrate a low level of perceived preference for video consultation and highlight both the high level of unfamiliarity using video calling / conferencing software and inability for a significant proportion to access the necessary hardware to participate in video consultation at all. We conclude as a department, that changing to video consultation from telephone consultation as a standard means of remote consultation will not increase patient satisfaction and will focus our attention and resource allocation on other areas of practice to improve our patient's experiences.
ABSTRACT
Objective: In Ireland there are difficulties accessing public outpatient services across all specialties. With a population of just under 5 million, it is estimated that there were 550,000 patients on waiting lists for first hospital outpatient visits at the end of 2019. Fertility services are particularly poorly resourced. Fertility is very time sensitive, with the biggest prognosticator in terms of the success of assisted reproduction treatment being female age. Long wait times are therefore detrimental for these patients and international comparisons show that Irish patients are older when they access fertility treatment. We noticed that there was a very poor attendance rate at our public infertility clinics, possibly exacerbated by the long wait time for an appointment. The aim of this study was to implement a new appointment strategy to address these unacceptably long waiting times and to reduce the “did not attend” (DNA) rate. Ultimately reducing the number of clinic appointments per patient and reduced waiting time to treatment and pregnancy. Design: Retrospective comparative study Materials and Methods: Prior to 2019, referral letters from family doctors were triaged by hospital nursing staff. Patients were sent an appointment slot and asked to complete specific fertility investigations (hormone profile and semen analysis) at the hospital prior to their scheduled appointment. From March 2019, all patients were asked to complete and return a lifestyle and medical history questionnaire and to have the required tests performed at the hospital. Only then was an outpatient appointment slot was scheduled. The outcome of all referrals received between March and August 2019 (new system) was compared with that of patients referred between March and August 2018 (old system). Results: A total of 185 patient files were reviewed – n 78 (2018);107 (2019) Post implementation of the new system, the DNA (did not attend) rate was reduced from 32% to just 2%. Less than half of those initially referred (39%) returned the questionnaire and completed the required investigations therefore receiving an appointment. For those who were given an appointment in 2019, the waiting time averaged 52 days compared to 178 previously. The total number of clinic visits needed to complete the basic work up reduced from two to one. Disappointingly, it took, on average, 189 days to complete the basic investigations. However this is compared to almost a year (326 days) in 2018. The rate limiting factor contributing to this was the waiting time for a pelvic ultrasound, with the average wait being 120 days after initial consultation. Almost one third of the women attending our clinic fell into the 35 – 39 age group category. Such a wait is not acceptable at this age. Conclusions: By ensuring patients complete their basic investigations before they receive an appointment, we have drastically reduced waiting times and the DNA rate. Now more than ever in this post COVID-19 era, we should aim to be streamlined and cost effective, prioritising our patients access to outpatient care. This approach could be adopted by other clinical services in Ireland to reduce clinic waiting times.