ABSTRACT
INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic led to hospitals in the UK substituting face-to-face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the use of virtual two-week wait (2-ww) lower gastrointestinal (LGI) clinic appointments, conducted using telephone calls at a district general hospital in England. METHODS: Patients undergoing index outpatient 2-ww LGI clinic assessment between 1 June 2019 and 31 October 2019 (FtF group) and 1 June 2020 and 31 October 2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets was assessed. Environmental and financial impact analyses were performed. RESULTS: In total, 1,531 patients were analysed (median age=70, male=852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone; the remainder were seen FtF (n=774, 50.6%). Ninety-two (6%, VC=44, FtF=48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC); of these, 46 (71.9%, VC=26, FtF=20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p<0.001). The cancer detection rates (p=0.749), treatments received (p=0.785) and median time to index treatment for CRC patients (p=0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p<0.001). VC appointments saved patients a total of 9,288 miles, 0.7 metric tonnes of CO2 emissions and £7,482.97. Taxpayers saved £80,242.00 from VCs. No formal complaints were received from patients or staff in the VC group. CONCLUSION: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits.
ABSTRACT
Introduction: The Right Iliac Fossa Pain Treatment (RIFT) study highlighted the rate of negative appendicectomies in the UK as one third of all procedures. However, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID) pandemic has changed surgical practice. New practices in the COVID era have changed the rate of negative appendicectomies. Methods: A retrospective analysis was conducted of patients admitted with appendicitis from March 2020 to June 2020. Patient Demographics: 58 patients were identified, 43 (74%) were adults and 15 (26%) were children. The median age of the adults was 33 (range 18-80) and the median American Society of Anaesthetists (ASA) grading was 1. The median age of children was 11 (range 4-17) and all were ASA grade 1. Results: 73.8% (31) of adult patients had a Computerised Tomography (CT) scan as part of their workup. 40% of paediatric patients underwent an ultrasound scan of the abdomen whilst the remaining 60% were diagnosed clinically. The open approach was favoured in both cohorts (39.5% and 46.7% respectively). No negative appendicectomies were performed. Conclusion: COVID19 has changed practice resulting in better outcomes for colorectal units. Further studies (COVID SURG and COVID HAREM) are needed to fully assess the role of imaging in reducing the number of negative appendicectomies.