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Introduction The ever-greater prevalence of cardiovascular disease has placed increasing pressure on cardiology services in the UK to achieve higher efficacy and improved quality of care. Telemedicine is emerging as a cost effective way to enhance patient's care. With the COVID19 pandemic, vitualconsultation had been became more widely used. The effectiveness and safety of tele-health intervention in cardiovascular condition in the UK remains unclear. Aim To describe our early experience and outcomes setting up virtual teleconsultation for stable follow up cardiology patients in a district general hospital. Method Since April 2019, a single cardiologist (AF) started enrolling selected stable cardiology follow up patients onto the virtual follow-up. Following the initial standard consultation, the results of the investigations would be reviewed by the attending cardiologist and subsequent consultation would be carried out via pre-arranged telephone appointment if patients are agreeable. Patient's outcomes and satisfaction survey were collated, sustainability and social benefits and environmental impact of the pilot were analysed. Result A total of 116 patients were enrolled into the pilot. Fifty eight percent were males with an average age of 67 years (range 26-93). Conditions enrolled were: stable ischaemic heart disease (put numbers and percentage 42%), Stable valvular heart disease (26%), arrhythmias (13%), heart failure (9%) and others (9%). Sixty patients (52%) were discharged and 42% (49) patients had further routine tele-clinic follow-up. There were 6% (7) patients failed to attend the telephone consultation. Patients feedback was overwhelmingly positive with the main themes being: Convenience, avoiding car parking congestion, avoiding traffic / transportation issues as well as avoiding overall visit costs. The main concerns raised in patients using tele-consultation were related: 1) Mobile phone connectivity 2) Privacy issues and 3) Logistic of completing pre-requisite investigation prior appointment. Figure 1 demonstrates the clinic's sustainability benefits. The did not attend (DNA) rates were significantly less compared to standard clinic (5.8% vs 8.2%). This pilot saved the trust c.a £3000 on consumables and logistics support and maximised outpatient clinic capacity utilisation. Conclusion Telemedicine had been shown to be a safe and effective method in the care of stable cardiology patients. The social, economic and environmental benefit of tele-consultation raised exciting opportunity for future service designs. Collaboration between hospital specialist, management team, community health providers and communication service suppliers are vital to ensure the sustainable implementation of telemedicine in cardiology.
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BACKGROUND: There is limited evidence on perioperative outcomes of surgical patients during the COVID-19 pandemic to inform continued operating into the winter period. METHODS: We retrospectively analysed the rate of 30-day COVID-19 transmission and mortality of all surgical patients in the three hospitals in our trust in the East of England during the first lockdown in March 2020. All patients who underwent a swab were swabbed on or 24 hours prior to admission. RESULTS: There were 4,254 patients and an overall 30-day mortality of 0.99%. The excess surgical mortality in our region was 0.29%. There were 39 patients who were COVID-19 positive within 30 days of admission, 12 of whom died. All 12 were emergency admissions with a length of stay longer than 24 hours. There were three deaths among those who underwent day case surgery, one of whom was COVID-19 negative, and the other two were not swabbed but not suspected to have COVID-19. There were two COVID-19 positive elective cases and none in day case elective or emergency surgery. There were no COVID-19 positive deaths in elective or day case surgery. CONCLUSIONS: There was a low rate of COVID-19 transmission and mortality in elective and day case operations. Our data have allowed us to guide patients in the consent process and provided the evidence base to restart elective and day case operating with precautions and regular review. A number of regions will be similarly affected and should perform a review of their data for the winter period and beyond.