Patient satisfaction from ENT telephone consultations during the coronavirus disease 2019 pandemic

Delivering a net zero National Health Service: where does otorhinolaryngology - head and neck surgery stand?

OBJECTIVE

The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice.

METHOD

Systematic review of the literature using scientific, healthcare and general interest (public domain) databases.

RESULTS

The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel.

CONCLUSION

Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.

Effect of COVID-19 on outpatient services in patients with aortovascular disease: a UK multicentre study

INTRODUCTION

The SARS-CoV-2 coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare services worldwide. Outpatient services have necessarily been restructured to accommodate COVID-19 patients and to maintain social distancing measures. The aim of our study was to investigate how the COVID-19 pandemic has affected outpatient healthcare provision for patients with aortovascular disease.

METHODS

In this prospective study, a standardised proforma was circulated to seven aortic centres in the UK. Data on outpatient encounters were collected from March to July 2020. Captured data included demographic details, disease pattern, type of encounter (face-to-face, video or telephone), clinic outcome and availability of imaging.

RESULTS

A total of 632 patients were included in the study, including 164 (25.9%) new referrals. In this cohort, clinic settings have shifted towards remote consultations, with 424 (67.1%) patients undergoing telephone appointments. Over a third of new patients (34.8%) had a delay in diagnostic tests, which might be attributable to the indirect effects of COVID-19. A total of 102 (16.1%) patients were added to a surgical waiting list following clinic.

CONCLUSIONS

To the best of our knowledge, this is the largest study of outpatient activity during the COVID-19 pandemic in patients with aortovascular disease. We demonstrate how the speciality has adapted to accommodate government-endorsed changes in healthcare provision, and question how COVID-19 may have affected access to diagnostics. Finally, we discuss how COVID-19 will affect patients added to surgical waiting lists.

Telephone triage for 2-week-wait cancer clinics: a viable alternative to face-to-face clinics?

INTRODUCTION

Head and neck cancer services have had to adapt to reduce the risk of exposure to patients and staff during the pandemic. Telephone consultations as a first point contact have been adopted in some centres. It is important that this does not lead to delays in diagnosis. Our hospital adopted a telephone triage service and we aim to describe the implications of this structure.

METHODS

Data were collected from all new patients referred to the head and neck 2-week-wait (2ww) pathway from June to September of 2019 and 2020. Days between first clinic appointment and cancer or noncancer diagnosis were calculated. Statistical tests were performed between years.

RESULTS

A total of 215 patients in 2019, and 165 in 2020 were included; 23 (6.8%) cancer diagnoses were identified across 2019 and 2020 groups. The cancer group had a mean time from first consultation to date of diagnosis of 16.33 days in 2019 and 12.81 days in 2020. There was no significant difference in days until diagnosis between 2019 and 2020 (p=0.05). In the noncancer group there was no significant difference in days until noncancer diagnosis (p=0.05). In 2020 26.1% (n=43) patients did not need to be seen face-to-face (f2f) under the 2ww pathway after telephone triage.

CONCLUSIONS

No difference in diagnosis timing was observed between cancer and noncancer patents in 2019 and 2020. Telephone clinics reduce the total number of f2f appointments required. Reduction in the number of f2f appointments may have other benefits in saving time and environmental costs.

A retrospective cohort study of telephone versus face-to-face clinics for the management of new otology referrals

PURPOSE

To compare outcomes of telephone and face-to-face consultations for new otology referrals and discuss the wider use of telemedicine in otology.

METHODS

Retrospective cohort study including new adult otology referrals to our unit, sampled consecutively between March 2021 and May 2021, seen in either a face-to-face or telephone clinic. Primary outcome measure was the proportion of patients with a definitive management outcome (discharged or added to waiting list for treatment) versus the proportion of patients requiring follow-up for further assessment or review.

RESULTS

150 new patients referred for a routine otology consultation (75 telephone, 75 face-to-face) were included. 53/75 patients (71%) undergoing a face-to-face consultation received a definitive outcome following initial review, versus 22/75 (29%) telephone patients (χ² < 0.001, OR 5.8). 52/75 (69%) telephone patients were followed up face-to-face for examination. The mean (SD) number of appointments required to reach a definitive outcome was 1.22 (0.58) and 1.75 (0.73) in the face-to-face and telephone cohorts, respectively (p < 0.001).

CONCLUSIONS

Telephone clinics in otology have played an important role as part of the COVID19 response. However, they are currently limited by a lack of clinical examination and audiometry. Remote assessment pathways in otology that incorporate asynchronous review of recorded examinations alongside audiometry, either conventional or boothless, may mitigate this problem; however, further research is required.

Availability of Medical Services and Teleconsultation during COVID-19 Pandemic in the Opinion of Patients of Hematology Clinics-A Cross-Sectional Pilot Study (Silesia, Poland)

A new virus, SARS-CoV-2, emerged in December 2019, triggering the COVID-19 pandemic in 2020 due to the rapid spread and severity of cases worldwide. In Poland, the first case of COVID-19 was reported on 4 March 2020. The aim of the prevention efforts was primarily to stop the spread of the infection to prevent overburdening the health care system. Many illnesses were treated by telemedicine, primarily using teleconsultation. Telemedicine has reduced personal contact between doctors and patients and reduced the risk of exposure to disease for patients and medical personnel. The survey aimed to gather patients' opinions on the quality and availability of specialized medical services during the pandemic. Based on the data collected regarding patients' opinions on services provided via telephone systems, a picture was created of patients' opinions on teleconsultation, and attention was drawn to emerging problems. The study included a 200-person group of patients, realizing their appointments at a multispecialty outpatient clinic in Bytom, aged over 18 years, with various levels of education. The study was conducted among patients of Specialized Hospital No. 1 in Bytom. A proprietary survey questionnaire was developed for the study, which was conducted on paper and used face-to-face interaction with patients. Results: 17.5% of women and 17.5% of men rated the availability of services during the pandemic as good. In contrast, among those aged 60 and over, 14.5% of respondents rated the availability of services during the pandemic as poor. In contrast, among those in the labor force, as many as 20% of respondents rated the accessibility of services provided during the pandemic as being well. The same answer was marked by those on a pension (15%). Overwhelmingly, women in the age group of 60 and over showed a reluctance toward teleconsultation. Conclusions: Patients' attitudes toward the use of teleconsultation services during the COVID-19 pandemic varied, primarily due to attitudes toward the new situation, the age of the patient, or the need to adapt to specific solutions not always understood by the public. Telemedicine cannot completely replace inpatient services, especially among the elderly. It is necessary to refine remote visits to convince the public of this type of service. Remote visits should be refined and adapted to the needs of patients in such a way as to remove any barriers and problems arising from this type of service. This system should also be introduced as a target, providing an alternative method of inpatient services even after the pandemic ends.

Telemedicine and Telementoring in Rhinology, Otology, and Laryngology: A Scoping Review

Objective

Telemedicine and telementoring have had a significant boost across all medical and surgical specialties over the last decade and especially during the COVID-19 pandemic. The aim of this scoping review is to synthesize the current use of telemedicine and telementoring in otorhinolaryngology and head and neck surgery.

Data Sources

PubMed and Cochrane Library.

Review Methods

A scoping review search was conducted, which identified 469 articles. Following full-text screening by 2 researchers, 173 articles were eligible for inclusion and further categorized via relevant subdomains.

Conclusions

Virtual encounters and telementoring are the 2 main applications of telemedicine in otolaryngology. These applications can be classified into 7 subdomains. Different ear, nose, and throat subspecialties utilized certain telemedicine applications more than others; for example, almost all articles on patient engagement tools are rhinology based. Overall, telemedicine is feasible, showing similar concordance when compared with traditional methods; it is also cost-effective, with high patient and provider satisfaction.

Implications for Practice

Telemedicine in otorhinolaryngology has been widely employed during the COVID-19 pandemic and has a huge potential, especially with regard to its distributing quality care to rural areas. However, it is important to note that with current exponential use, it is equally crucial to ensure security and privacy and integrate HIPAA-compliant systems (Health Insurance Portability and Accountability Act) in the big data era. It is expected that many more applications developed during the pandemic are here to stay and will be refined in years to come.

Patients' Satisfaction With Telepsychiatry Services at a University Hospital in Riyadh During the COVID-19 Pandemic

Background and objective

Telepsychiatry uses electronic communication and various technologies to provide psychiatric care by a psychiatrist in one location to a patient in another location. It was originally created to meet the mental health needs of patients in rural, remote, and inaccessible areas. This study aimed to assess the satisfaction level with telepsychiatry from patients' perspectives and to study whether the satisfaction levels influence the patients' decision to use the service in the future.

Methodology

This was a cross-sectional survey study conducted at King Khalid University Hospital in Riyadh, Saudi Arabia. The study included psychiatric patients with complete medical records who were followed up through the telepsychiatry program over the phone due to the restriction and regulation implemented by the government in the wake of the coronavirus disease 2019 (COVID-19) pandemic. The data were collected via a questionnaire designed on a Google Form. Initially, the sample size was set at 337 psychiatric patients, but only 141 patients agreed to be included. The SPSS Statistics program (IBM, Armonk, NY) was used to analyze the data.

Results

Patients were generally satisfied with the telepsychiatry services; 80.1%, 95.7%, and 96.5% of the participants were satisfied with the structure, process, and outcome, respectively, and 94.3% of the patients reported a sense of overall satisfaction. The study did not find any relationship between satisfaction and demographic characteristics. Patients highly valued some aspects during the service use, such as comfort, privacy, easy access, carefulness, and skillfulness of the clinicians. Of the respondents, 24.1% agreed and 24.8% strongly agreed when asked if they would use the service in the future.

Conclusion

Patients had generally positive satisfaction levels toward telepsychiatry service, and many reported that they would like to continue using it in the future. However, further studies are needed to assess whether patient perception will change over time after the COVID-19 pandemic.