Improving efficacy and sustainability of virtual cardiology clinics

ABSTRACT

IntroductionSocial distancing measures were introduced in Ireland to address COVID-19 in March 2020. Strategies to continue Cardiology outpatient services needed to balance patient safety with the need for high quality follow-up care. Therefore, virtual consultations (via phone or video call) were implemented as temporary alternatives to in-person clinics.Objectives and MethodologyWe aimed to identify inefficiencies in physical outpatient services at Beaumont Hospital in comparison with virtual consultations. In face-to-face visits, a patient’s average time outside the physician’s examination room was 39 minutes (range 12-110 minutes). Increased delays occurred if investigations were awaited. The average face-to-face consultation lasted 24 minutes. Next, an analysis was performed on 100 consecutive patients’ virtual consultation experiences. Electronic survey responses were collected from stakeholders including patients, physicians, nurses, and clerical staff relating to these virtual visits.Results81% of outpatient consultations were delivered virtually from July to December 2021, with an average duration of 19 minutes. Patient volume was increased (5 additional patients per week per clinic) with a reduced waiting time for routine attendance. Criteria for outpatient re-attendance was regularly reviewed, with discharge facilitated at the second or third visit if clinically indicated. 89% of visits were supported by communications technology (smartphone or internet access) and 94% had access to a private location. 76% of patients reported that they were able to access their appointment without limitations in comparison to in-person consultations, although some reported a decreased personal connection with their physician. Satisfaction scores reflected this positive outlook (90/100 for patients and 75/100 for physicians), although patients reported that they would prefer virtual consultations less than 50% of the time outside the pandemic. Information was collected from patients on what aspects could be improved on the virtual service.Conclusion and ImplicationsVirtual clinics could be increasingly implemented in modern Cardiology. Telemedicine could provide a high-quality service with reduced cost and increased accessibility, particularly for patients in rural areas. In addition, virtual care at scale could allow in-person visits to be prioritised for patients who would truly benefit from their use, while reducing the risk of transmissible infections including COVID-19 and others.