TELEUROLOGY: EXPANDING HORIZONS TO INPATIENT ECONSULTS

ABSTRACT

INTRODUCTION AND OBJECTIVE: Telemedicine use rapidly increased during the COVID-19 pandemic. However, the efficacy of telemedicine in the inpatient setting has yet to be addressed. To this end, we measured patient and provider satisfaction with video and faceto- face (FTF) consults for inpatient urology consultations and sought to identify the urologic conditions most suitable for video consults. METHODS: New inpatient urology consults between August 2021-October 2021 were randomized to either video or FTF consult. Patient surveys were administered within 24 hours to assess satisfaction and perceived quality of care during the consult (3-point ordinal Likert scale). Survey results were analyzed using Mann- Whitney U tests. Participating urology attendings completed a survey assessing satisfaction and utility of both consultation mediums (3- point ordinal Likert scale), and suitability of video consults for common urologic consultation conditions (5-point ordinal Likert scale). RESULTS: A total of 48 patients were included;23 (48%) received video consult and 25 (52%) FTF consults. There were no significant differences in age or race between the cohorts. The most common reasons for consultation were acute urinary retention (Video 5 [22%], FTF 5 [20%]) and urolithiasis (Video 5 [25%], FTF 3 [12%]). Both cohorts agreed that they were overall satisfied with their visit (Video 22 [95.7%], FTF 25 [100%];p=0.297), received high-quality care (Video 22 [95.7%], FTF 23 [92.0%];p=0.61), and would accept the visit modality again in the future (Video 21 [91.3%], FTF 25 [100%];p=0.14). Urologists agreed on the utility of both consultation mediums, including ability to gather complete information (Video 7 [100%], FTF 7 [100%]) and manage the patient (Video 6 [85.7%], FTF 7 [100%];p=0.71). Physician satisfaction was lower for video consult than FTF (Video 5 [71.4%], FTF 7 [100%];p=0.38), and physicians were less likely to agree that video consults were satisfactory compared to FTF visits (4 [57.1%]). The most suitable urologic conditions for video consultation were elevated PSA and urinary retention (4.85±0.38), followed by urinary incontinence and nephrolithiasis (4.71±0.49). The least suitable was scrotal wall swelling (2.71±0.76). CONCLUSIONS: With increasing telemedicine utilization, video consults offer an alternative to FTF rounding that may combat difficulties of urologist shortages. Video consults enable urologists to see a wide variety of inpatient consults without hindering patient satisfaction. However, adoption of this tool will rely on physician preference and competence with video technology.