Telemedicine in a tertiary rhinology and endoscopic skull base surgery practice: Utility, impact, and patient satisfaction in the post-COVID-19 era

ABSTRACT

Introduction: Telemedicine may be a strategy to provide timely care to patients in the rhinology and endoscopic skull basesurgery (ESBS) practice due to the coronavirus disease-19 (COVID-19) pandemic. Few studies have investigated its utilityin otolaryngology, and none have assessed its application to the ESBS practice. This study aims to assess the utility oftelemedicine to increase patient access and determine patient satisfaction in this setting. Methods: This project was considered as a quality improvement initiative and was therefore exempt from institutionalreview board review. A retrospective chart review between July 1 and August 31, 2020, extracted demographic and clinicalinformation from new patient telemedicine and in-person visits in our ESBS practice (rhinology and neurosurgery). Aseparate phone survey was conducted in a subset of patients after their visits answering questions related to satisfactionscored on a 5-point Likert scale ([ Fig. 1 ]). Univariate analysis with Mann-Whitney and Fisher's exact tests were performed for continuous and categorical variables. Results: Overall, there were 137 patients who were seen in-person or via telemedicine. Mean age was 52.7 ± 16.2 years, 59(43.1%) were white, and 85 (62.0%) were female. The majority, 115, (84.0%) were seen by an otolaryngologist and 22(16.1%) by a neurosurgeon. One-hundred thirteen (82.5%), 18 (13.1%), and 6 (4.4%) patients underwent in-office, video,and telephone visits, respectively. The median distance from patient residence to the clinic was 12.3 miles (range 0.6-184.0). The median round-trip drive time was 52 minutes (range 6.0-420.0;[ Fig. 2 ]). Median expected round-trip drivetime did not significantly differ between telemedicine and in-person visits (58 and 52 minutes, respectively). For those whoreceived phone surveys ( N = 30), the mean age was 50.0 ± 14.7 years, 15 (50.0%) were African American, and 17 (56.7%)were female. Twenty-five (83.3%) and 5 (16.7%) patients had an otolaryngology and neurosurgery appointment,respectively. Seventeen (56.7%), 11 (36.7%), and 2 (6.7%) patients had an in-office, video, and telephone visit,respectively. Half were new and half were return visits. The majority (27/30, 90%) reported overall satisfaction with theirvisit as defined by a score of 4 or 5 on the Likert scale, and 20/30 (66.7%) believed telemedicine to be more convenientthan in person. Nevertheless, the majority (20/30, 66.7%) expressed a preference for a future visit to occur in person.Patient satisfaction was not associated with age, race, mode of visit (telemedicine vs. in person), visit specialty, or visitstatus (new vs. return;p > 0.05, all). Conclusion: Patients with rhinology and skull base pathology would gain better access to care with less travel time usingtelemedicine. Although the majority were satisfied with telemedicine and its convenience, most patients still prefer in-person consultation. Telemedicine could prove useful in screening patients in the tertiary ESBS setting in the post-COVID-19 era prior to in person evaluation.