ABSTRACT
NHS England identified Patient Initiated Follow Up (PIFU) as part of NHS COVID-19 recovery, in line with the personalised- care agenda. We aimed to assess how the introduction of PIFU for neurology patients at Croydon University Hospital (CUH) has impacted patient outcomes, capacity and non-elective admissions. Data were extracted from electronic records on all patients booked into a CUH neurology PIFU appoint- ment from 1st June to 29th October 2021. Data were collected on the number of admissions or outpatient attendances for 5 years pre-PIFU appointment and compared with 0-6 months post-PIFU. 355 patients had a PIFU appointment at CUH neurology between 1st June and 29th October 2021. The most common neurological conditions prompting a PIFU appointment were epilepsy (40%), multiple sclerosis (22%) and Parkinson's disease (12%). The average number of outpatient appointments reduced from 11.0 pre-PIFU to 1.5 post-PIFU. The average number of ED attendances reduced from 3.1 pre-PIFU to 0.4 post-PIFU. Although there are significant limitations in this study (inadequate time since appointment, the pandemic), we remain keen on PIFU and had been running an advice line service before it was labelled as PIFU. Further follow-up data and patient satisfaction data is needed.
ABSTRACT
COVID-19 forced a swift change to remote neurology outpatient appointments in order to reduce hospital footfall. The impact of this change on diagnosis, investigations requested, and follow up was unknown. This retrospective study compared 100 general neurology outpatients assessed remotely by a single clinician in 2020, to 100 patients assessed face to face during a similar time frame in 2019. The aim of the study was to identify if remote consultations are a feasible alternative, and if their use resulted in increased numbers of investigations or repeat consultations. There were similar numbers of urgent investigations ordered in 2019 and 2020 (9% and 7% respectively);however, fewer routine investigations were requested (7% compared with 38%). Of 58 new outpatients in 2020, 12% required video assessment, and 1 required a physical review. An additional 10% consultations were needed in 2020. The discharge rate was similar in both cohorts (41% and 44%). Follow up plans were similar between the 2 cohorts, despite an increase in 2020 of 6 month follow up appointments. This study demonstrates remote neurology outpatient consultations are feasible outside the pandemic. We propose follow up appointments could be done remotely as a default and potentially for some selected new patients.
ABSTRACT
Croydon University Hospital Remote consultations were rapidly introduced in the spring of 2020 in the neurology outpatient setting across the UK and worldwide due to the Covid-19 pandemic. Consulting remotely provides new chal-lenges to previously familiar practices. Here we present four different but commonly seen cases in a south London outpatient neurology service. With each case we address a key domain: history taking, examina-tion, the digital divide and changing the consulting environment. History taking is largely unchanged and indeed may improve the patient experience when performed in a familiar environment. The examina-tion is different and a greater understanding of which aspects of the neurological exam are and are not possible remotely continues to be discussed. The adoption of remote consultations requires patients to have a confident ability to activate and interact with technologies. The future development of technolo-gies and guidelines should proactively engage with patients of all ages and abilities to avoid biases in their development. Remote consultations are likely to continue to play a part in the future of outpatient neurology;understanding their most effective allocation and proactively developing technologies with patients will be essential for their success.