ABSTRACT
The COVID-19 pandemic has resulted in an unprecedented change to service delivery within the National Health Service (NHS). After the UK government advised general practitioners to conduct consultations remotely where possible, remote consultations rose from < 30% before the pandemic to almost 80% of consultations at the height of the pandemic. After the national lockdown was lifted, remote consultations continued to account for > 70% of consultations. Telemedicine has previously been shown to be an effective model for triaging referrals from primary care to 2-week-wait (2WW) skin cancer clinics. However, to our knowledge, no study has assessed the impact of telemedicine in assessing patients remotely at their initial primary care consultation prior to referral to secondary care. Our study aimed to assess whether the mode of consultation [face to face (F2F) or remote] in primary care affected the outcomes of consultations in 2WW skin cancer clinics. In total, 988 patients were referred to the 2WW clinic in September 2020. Of these, 37 9% (n = 375) were referred after F2F consultations in primary care. Thirty-seven per cent (n = 364) were referred after remote consultations, with the majority being telephone consultations with photographs (76%). The mode of primary care consultation was unclear in 21 1% (n = 209) of patients. A higher proportion of patients who had remote consultations were discharged (43 4%;n = 158/364) from the 2WW clinic than patients who had F2F consultations (36 2%;n = 136/375). There was a significantly higher number of benign lesions referred following a remote consultation in primary care compared with a F2F consultation (70% vs. 59%;P = 0 004). Interestingly, there was a higher proportion of benign lesions referred after telephone consultations with photographs vs. those without. The accelerated use of telemedicine in the COVID-19 era will provide useful information on how telemedicine can be optimized in the future. Lessons learnt during this time will inevitably shape the future digital landscape within the NHS. A key ambition set out in the NHS Long Term Plan published in January 2019 was to increase remote consultations within primary care. While remote consulting certainly has a role in some settings, our study highlights the value of F2F consultations for the initial assessment of patients presenting with lesions in primary care, in order to reduce the number of unnecessary referrals and hospital visits.
ABSTRACT
Background University Hospitals of Morecambe Bay NHS Trust, witnessed an early peak of COVID-19 with related hospital admissions in early 2020, this created a need for a coordinated approach to post COVID-19 rehabilitation needs across the area. Objectives A three-armed COVID-19 rehabilitation pathway was devised in March 2020 with Arm 1 aiming to assess and address the immediate rehabilitation needs of those leaving hospital following an admission for respiratory complications of COVID-19. Methods Existing Pulmonary Rehabilitation teams were repurposed by integrated care network (MBRN) to be a new 'Virtual' rehabilitation service. A register of patients discharged from hospital sites was remotely screened for pathway suitability. Then, using a multi-professional template a holistic assessment needs was conducted using telephone and/or home visit consultations. Clinical assessment tools were built into the assessment process. Weekly 'acute-community' virtual in-service training sessions and multi-disciplinary case discussions supported the clinicians. Results To date 207 patients have entered the service for virtual triage, 138 patients were deemed suitable for further assessment and interventions. 427 direct clinician consultations were delivered to these 138 patients [122 initial telephone assessments;53 initial home visit assessments;168 follow-up telephone consultations;84 follow-up home visits]. Two of the 138 patients assessed died, both were expected deaths. No clinical incidents occurred and no staff contracted COVID-19 during this period. Feedback from the services' staff survey was very positive highlighting the supportive value of virtual training and MDT and the enjoyment of being part of creating and delivering this new service to patients recovering from COVID-19. Conclusions Utilising the skills of pulmonary rehabilitation staff to deliver a holistic rehabilitation and treatment service to those discharged from hospital after suffering respiratory complications of COVID-19 was feasible, safe and well tolerated by staff and patients. This service is now being used to address the needs of post-COVID-19 patients presenting with respiratory needs in the community. We aim also to assess clinical outcome.
ABSTRACT
As a result of the COVID-19 pandemic, routine dermatology appointments in our trust were suspended from March 2020. In response, we later introduced virtual telephone and video consultations using accuRx for new routine dermatology referrals. Although supported by guidance from the British Association of Dermatologists, there is a relative lack of evidence for use of the virtual consultation (VC) in routine dermatology. We therefore sought to assess its practicality and effectiveness, and reflect on the experience. We undertook a review of 200 consecutive routine new patient VCs by an experienced general practitioner (GP) associate specialist during lockdown. Patients were allocated a specific time for the consultation. The outcomes, diagnosis, type of dermatology presentation and the use of video were recorded. This was compared with 200 routine new patients seen face to face (F2F) by the same GP associate specialist in 2019. Both groups showed similar demographics (57% females, 43% males, mean age 52.1 years). Owing to the COVID-19 pandemic, average waiting times were significantly longer for VCs (33.6 weeks vs. 15.5 weeks;P < 0.001). Did not attend/answer rates were very similar (VC 9.5%, F2F 10.5%). AccuRx video was used successfully for 32.5% of the patients in the VC group. Of the remaining VC patients, 30.5% did not require video, 23.5% said it was not possible (no mobile phone, lack of technical experience, inappropriate location, patient refusal) and 3.5% failed. The 'not possible' group were older, with a mean age of 69.2 years (P < 0.001). Dermatological presentations were similar in both groups (49% lesions, 27% inflammatory rashes, 11% other rashes, 13% miscellaneous). Fewer patients were discharged from VC after the first consultation (VC 15%, F2F 26%) and fewer referred for minor surgery (VC 22%, F2FC 27%). More VC patients were referred for routine follow-up (VC 37%, F2FC 16%). More lesions were followed-up routinely after VC (VC 39%, F2F 7%). Additionally, fewer patients with lesions were discharged after VC (VC 7%, F2F 37%). VC may have a role in the management of the long referral waiting times generated by COVID-19 in the future. We conclude that VC is a satisfactory method of assessing some new routine patient referrals but does create more routine follow-up work particularly for patients with lesions. VC requires a committed and organized practitioner, has advantages for the patient, a potential triage role and possible cost savings for the National Health Service. We recommend seeking patient feedback concerning the VC process and analysing final diagnosis outcomes in both groups.
ABSTRACT
P35 Figure 1ConclusionsUtilising the skills of pulmonary rehabilitation staff to deliver a holistic rehabilitation and treatment service to those discharged from hospital after suffering respiratory complications of COVID-19 was feasible, safe and well tolerated by staff and patients. This service is now being used to address the needs of post-COVID-19 patients presenting with respiratory needs in the community. We aim also to assess clinical outcome.