ABSTRACT
Objective: Following the creation of a quality improvement (QI) lead in the Oxford adult CF service, key areas for development were identified. Increased use of virtual care and CFTR modulators highlighted a need to adapt our transition process to meet the changing needs of young people with CF (pwCF). Our aim was to facilitate collaboration across adult and paediatric teams to identify areas for improvement. Method: We led a process of stakeholder engagement including meeting with other CF and non-CF transition services. Multidisciplinary Team (MDT) QI meetings were held within the adult service to identify whatwas considered a successful transfer of care. We observed the first in-person transition clinic since the pandemic, and distributed electronic surveys of the clinic experience to pwCF, carers, and staff. Lastly, we held a virtual cross-service QI meeting to present findings, aiming to reach consensus on areas for change. Results: 5/5 pwCF and 5/5 carers completed the clinic surveys. Both identified their main priorities: to meet the adult team and receive a clinical review. Comments identified anxiety discussing future life plans too young or repetitively. 3/5 pwCF and 3/5 carers preferred the carer to be present throughout the visit. 7/9 staff completed the survey. There was general agreement of clinic objectives that 6/7 felt were met. Comments were around clinic location, pre-meeting, and coordinating MDTreviewcontent. Holding a face-to-face clinic was perceived as important. Overall, the MDTs agreed on 5 areas for improvement: documentation;patient information;clinic meetings;individual profession handovers;and identifying pwCF requiring bespoke transition. Conclusion: Protected time for QI provided a forum to bring paediatric and adult CF teams together to identify shared priorities for improvement of local transition care. A QI lead role has allowed us to drive service development during the COVID-19 pandemic and introduction of CFTR modulators.
ABSTRACT
Background: In response to the COVID-19 pandemic, the Oxford Adult CF Centre offered virtual clinics using the NHS Attend Anywhere platform from June 2020. We surveyed patient and staff experience. Methods: An anonymous online patient survey was added to appear at the end of all CF virtual consultations from July to November 2020. A separate anonymous staff survey was distributed by email to all members of the CF multidisciplinary team. Results: 136 responses were received (patient population of 141) and 12/19 (62%) of staff responded. 71% of patients rated a virtual review a very reasonable alternative to face-to-face and 83% felt all their clinical needs were met. 98% rated how comfortable they were to talk to clinicians as 4 or 5/5. 83% staff felt they could provide an acceptable standard of review to most patients. When asked if they could provide a high standard of review, 17% felt they could to most patients, with 58% feeling they could to some patients only. Time efficiency and patient attendance at virtual clinics were perceived as superior to face-to face. 86% of patients rated their satisfaction with the technology as 4 or 5/5, with 100% staff rating as 4/5. 11 negative patient comments related to technology. Poor sound quality and video lag were the main concerns identified by both patients and staff. 82% of patients would like to continue using virtual reviews in future and 100% staff wanted this to be an option for some appointments. Routine clinic visits were rated most popular appointments to be virtual in future by staff and patients. Conclusion: Virtual clinics have been well received by the majority of our adult CF patients during the COVID-19 pandemic. Patients and staff wanted to use virtual reviews in future, although both recognised this is not always suitable for all appointments.