Learning from Covid-19 Pandemic: Utilising Telephone Consultation in Colorectal Surgical Patients

ABSTRACT

Aim: This quality improvement project's aim is to see the difference in number of appointments and investigations between patients presenting via telephone or face to face (F2F) clinics. Method(s) We reviewed 61 referrals to Colorectal clinic between January and February 2021, 34 were telephone appointments, 22 F2F appointments and 5 were excluded due to unidentifiable patient data or incorrect referral. We assessed 14 different parameters. Result(s) The first phase data showed F2F clinic patients were older (n = 66.91 years vs 56.21 years), had more appointments (n = 1.72 vs 1.38) and a shorter RTT (Referral To Treatment) (n = 26.65 days vs 136 days). The shorter RTT correlates with the larger number of 2 week wait referrals that were seen in F2F clinic (n = 11) vs in the Telephone group (n = 3). Adjusting for patients with ongoing treatment in the F2F group (O-F2F) or telephone patients that awaited a F2F appointment for further investigation (T to F2F) the data showed that the O-F2F patients had 1.76 appointments vs 2.2 average appointments in the T to F2F patient group. Investigations were higher in the O-F2F group (n = 3 versus n = 0.5) vs the T to F2F group. There was a higher rate of DNA (Did Not Attend) (n = 11.7% versus 4.5%) and discharge (n = 20.5% versus n = 18%) in Telephone clinics vs F2F clinics. The most common reason for more appointments in the Telephone group was the inability to properly assess the patient's pathology and plan accordingly especially in benign proctological disease which was seen more commonly in the Telephone group. Conclusion(s) Risk stratification may be appropriate when deciding patients to attend telephone vs F2F clinics. A combination of red flag symptoms and increased age may be appropriate tools to start identifying suitable patients for F2F clinics. Patients with chronic or complex proctological disease likely need F2F appointments to reduce overall number of appointments which will expedite investigation and treatment. Telephone clinics may be appropriate for benign disease follow-up.