Patient satisfaction and patient costs associated with telephone clinic appointments in Inflammatory Bowel Disease (IBD) following the pandemic

Background: Prior to the COVID-19 pandemic, conventional management of outpatient care in IBD predominantly revolved around face-to-face clinic appointments. In the changing landscape of care provision during the pandemic, appointments were conducted almost exclusively through telephone consultation. An electronic questionnaire was developed to assess patient satisfaction and patient costs. Method(s): A pilot was carried out with 15 patients to identify any technical issues with e-mail delivery of the questionnaire and gauge face validity of the questionnaire content. 1400 patients registered with the TrueColours-IBD remote digital monitoring system were sent the questionnaire link via e-mail in May 2021. No demographic data were collected by design, in order to avoid the perception of bias and ensure freedom of expression through anonymity. Result(s): 506 responses were received including 21 duplicates which were excluded, totalling 485 valid responses. 408/485 patients reported having a telephone appointment with the IBD service since March 2020, 484/485 reported having had a face-to-face appointment in the past. 348/408 (86%) were either 'very satisfied' or 'somewhat satisfied' with their most recent telephone consultation, while 22 (6%) were either 'very dissatisfied' or 'somewhat dissatisfied'. 247/408 (61%) were also either 'very satisfied' or 'somewhat satisfied' with the ease of accessing further care if required, compared to 33/408 (8%) who were either 'very dissatisfied' or 'somewhat dissatisfied'. Given the choice, 195/408 (48%) patients preferred to receive a telephone appointment in the future;147/408 (36%) would opt for face-to-face and 66/408 (16%) stated no preference, all with the option of changing that choice if needed. Telephone appointments were associated with a mean total patient time off-work or leisure of 23 minutes (S.D. 51, n=408) compared to 190 minutes (S.D. 96, n=484) for face-to-face appointments. The average cost of time off work or leisure associated with telephone appointments was 5.55 (S.D. = 15.74, n=408), compared to 43.42 (S.D. = 31.27, n=484) for face-to-face appointments (Table 1). Costs of transport add further to face-to-face appointment costs. Greater proportions of patients had a companion for their face-to-face appointment and required childcare compared to telephone consultations (Table 2), which again increases the difference in costs. Conclusion(s): Almost half of surveyed patients stated a preference for telephone appointments, although a third still preferred traditional follow-up. An evolution of care pathways is supported by patient preference and the statistically significant time and cost savings to patients receiving telephone appointments. (Figure Presented).

Use of a cost-efficient Colonoscopy simulation model to improve endoscopy skills

Aims: The use of endoscopic simulators as a learning aid in surgical training has been well established, particularly in those with less experience. In the challenging time of COVID-19, when endoscopic procedures are at a minimum, this can become more valuable. However, their utility for training is countered by the high cost of equipment. We demonstrate a cost-efficient alternative to traditional endoscopy simultators, which can be easily made in any centre. Methods: A polypectomy simulator model was created using a drainpipe and surgical gloves. Junior doctors were timed in their ability to remove the 3 polyps from within the simulator. The exercise was repeated over 6 sessions over the course of 3 weeks. Means were compared using ANOVA. Results: There was a mean relative reduction of 75% in overall time taken to complete the task (p<0.0001). This improvement was seen for both surgical trainees with previous endoscopy experience (p=0.005) and FY1 novices (p<0.0001). Conclusions: In our group, we have seen improvement in performance across both surgical trainees and novices. In today's era of COVID-19, when direct training opportunities may become more scarce, simple alternatives may become vital in ensuring progression of basic surgical skills such as endoscopy. This cheap polypectomy simulator can be easily re-created across surgical units and can be used as an adjunct to traditional endoscopic training.

Use of a cost-efficient Colonoscopy simulation model to improve endoscopy skills during the COVID-19 pandemic

Introduction: The use of endoscopic simulators as a learning aid in surgical training has been well established. In the challenging times of COVID-19 they can become even more valuable. However, their utility for training is countered by the high cost of the equipment, with some of the most basic simulators costing upwards of £50,000. Method: A simple polypectomy simulator model was created using a drain-pipe and surgical gloves. n = 9 junior doctors (n = 4 surgical trainees, n = 5 FY1s) were timed in their ability to remove the 3 'polyps' from the simulator. Basic instructions regarding use of the colonoscope were given to novices unfamiliar with real-life endoscopy. The exercise was repeated over 6 sessions over the course of 3 weeks. Means were compared using ANOVA. Results: There was a mean relative reduction of 75% in overall time taken to complete the task (p <0.0001). This improvement was seen for both surgical trainees (P = 0.005) and FY1 novices (P < 0.0001). All junior doctors involved reported feeling more confident with basic Colonoscopic skills. Conclusion: We have demonstrated an improvement in performance times across both surgical trainees and novices. In the era of COVID-19, when direct training opportunities may become more scarce, simple alternatives may become vital in ensuring progression of basic surgical skills such as endoscopy. This cheap polypectomy simulator can be easily re-created across surgical units and can be used as an adjunct to traditional endoscopic training. Further work is required to determine whether this translates into improvement in clinical endoscopy.