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McCabe C, McCann M, Connolly D, McGrath J, Begley J, Ball JC, Harris E. Impact of unscheduled nurse-led virtual care for people with diabetes on nursing practices and patient satisfaction. Br J Nurs 2024; 33:236-241. [PMID: 38446518 DOI: 10.12968/bjon.2024.33.5.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND The COVID-19 pandemic and its social restrictions accelerated the expansion of virtual clinical care, and this has been reported to be safe, low cost and flexible. AIM This study aimed to examine nursing practices and patient satisfaction with unscheduled nurse-led virtual care for people with diabetes. METHODS A cross-sectional descriptive survey of clinical nurse specialists and patients was carried out, using an activities log for nursing practices and a satisfaction and enablement survey for callers. FINDINGS Patients reported high satisfaction levels and greater self-confidence in keeping themselves healthy after receiving virtual care. Most calls (74.8%) from patients were for advice and education. Each call led to an average of 2.5 actions for the clinical nurse specialist. CONCLUSION The service is highly valued and is effective, but adds to the nurse workload burden.
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Affiliation(s)
- Catherine McCabe
- Associate Professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Margaret McCann
- Associate Professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - David Connolly
- Research Assistant, Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin, Ireland
| | - Jackie McGrath
- Clinical Nurse Specialist Diabetes, Naas General Hospital, Naas, County Kildare, Ireland
| | - Joanne Begley
- Clinical Nurse Specialist Diabetes, Naas General Hospital, Naas, County Kildare, Ireland
| | - Jane C Ball
- Clinical Informatics Nurse, Naas General Hospital, Naas, County Kildare, Ireland
| | - Elaine Harris
- Nurse Practice Development Co-ordinator, Naas General Hospital, Naas, County Kildare, Ireland
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Zeh P, Young A, Gholap N, Randeva H, Robbins T, Johal K, Patel S, O'Hare JP. Diabetes specialist intervention in general practices in areas of deprivation and ethnic diversity: A qualitative evaluation (QUAL-ECLIPSE). Prim Care Diabetes 2024; 18:37-43. [PMID: 37926590 DOI: 10.1016/j.pcd.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
AIM To assess patients' and healthcare professionals' perspectives of a specialist-led Diabetes Risk-based Assessment Clinic (DIRAC) for people with diabetes at high risk of complications (PWDHRC) in areas of deprivation in Coventry, UK. METHODS A qualitative evaluation of a pilot trial, comprising a specialist team intervention (DIRAC), was undertaken in seven GP practices through observations of weekly virtual or occasional face-to-face patient consultations and monthly interventionists' meetings. Semi-structured interviews were carried out post-intervention, with PWDHRC, primary care clinicians and diabetes specialists (interventionists). Thematic analyses of observations and interviews were undertaken. KEY FINDINGS Over 12 months, 28 DIRAC clinics comprising 154 patient consultations and five interventionists' meetings, were observed. 19 interviews were undertaken, PWDHRC experienced 'culturally-sensitive care from a specialist-led clinic intervention encompassing integrated care. This model of care was recommended at GP practice level, all participants (PWDHRC, primary care clinicians and diabetes specialist interventionists) felt upskilled to deal with complex diabetes care. The EMIS and ECLIPSE technologies utilised during the intervention were perceived to positively contribute to diabetes management of PWDHRC despite reservations around cost and database. CONCLUSION The specialist-led DIRACs were largely appreciated by study participants. These qualitative data support the trial progressing to a full-service evaluation.
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Affiliation(s)
- Peter Zeh
- Centre for Healthcare Research, Faculty of Health & Life Sciences, Coventry University, Coventry CV1 5RW, UK; Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK.
| | - Annie Young
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Nitin Gholap
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Harpal Randeva
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Timothy Robbins
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Kam Johal
- Henley Green Medical Centre, Coventry CV2 1AB, UK
| | - Shweta Patel
- University Hospitals of Leicester NHS Trust, LE5 4PW Leicester, UK
| | - J Paul O'Hare
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
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Alawadhi A, Palin V, van Staa T. The impact of the COVID-19 pandemic on rates and predictors of missed hospital appointments in multiple outpatient clinics of The Royal Hospital, Sultanate of Oman: a retrospective study. BMC Health Serv Res 2023; 23:1438. [PMID: 38115022 PMCID: PMC10729569 DOI: 10.1186/s12913-023-10395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND The global outbreak of the COVID-19 pandemic resulted in significant changes in the delivery of health care services such as attendance of scheduled outpatient hospital appointments. This study aimed to evaluate the impact of COVID-19 on the rate and predictors of missed hospital appointment in the Sultanate of Oman. METHODS A retrospective single-centre analysis was conducted to determine the effect of COVID-19 on missed hospital appointments at various clinics at The Royal Hospital (tertiary referral hospital) in Muscat, Sultanate of Oman. The study population included scheduled face-to-face and virtual appointments between January 2019 and March 2021. Logistic regression models were used with interaction terms (post COVID-19) to assess changes in the predictors of missed appointments. RESULTS A total of 34, 3149 scheduled appointments was analysed (320,049 face-to-face and 23,100 virtual). The rate of missed face-to-face hospital appointments increased from 16.9% pre to 23.8% post start of COVID-19, particularly in early pandemic (40.5%). Missed hospital appointments were more frequent (32.2%) in virtual clinics (post COVID-19). Increases in missed face-to-face appointments varied by clinic (Paediatrics from 19.3% pre to 28.2% post; Surgery from 12.5% to 25.5%; Obstetrics & Gynaecology from 8.4% to 8.5%). A surge in the frequency of missed appointments was seen during national lockdowns for face-to-face and virtual appointments. Most predictors of missed appointments did not demonstrate any appreciable changes in effect (i.e., interaction term not statistically significant). Distance of patient residence to the hospital revealed no discernible changes in the relative effect pre and post COVID-19 for both face-to-face and virtual clinic appointments. CONCLUSION The rate of missed visits in most clinics was directly impacted by COVID-19. The case mix of patients who missed their appointments did not change. Virtual appointments, introduced after start of the pandemic, also had substantial rates of missed appointments and cannot be viewed as the single approach that can overcome the problem of missing hospital appointments.
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Affiliation(s)
- Ahmed Alawadhi
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Victoria Palin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Maternal and Fetal Research Centre, Division of Developmental Biology and Medicine, The Univeristy of Manchester, St Marys Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Tjeerd van Staa
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Urbonas T, Lakha AS, King E, Pepes S, Ceresa C, Udupa V, Soonawalla Z, Silva MA, Gordon-Weeks A, Reddy S. The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study. Patient Saf Surg 2023; 17:23. [PMID: 37644474 PMCID: PMC10466851 DOI: 10.1186/s13037-023-00368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to evaluate the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy. METHODS We conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates, with Clavein-Dindo grade III or greater deemed clinically significant. We performed a subgroup analysis on the cases cancelled on the day of surgery in an attempt to identify key reasons for cancellation following virtual clinic assessment. RESULTS We identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 7% of patients had a cancellation on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal to or greater than Clavien-Dindo grade III) were observed in 1% of patients, and required re-intervention. 30-day readmission rate was 11%. CONCLUSIONS Our series showed that it is safe and feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, its environmental impact, and possible benefits to healthcare economics to support its routine use in general surgery.
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Affiliation(s)
- Tomas Urbonas
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Adil Siraj Lakha
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Emily King
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Sophia Pepes
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Carlo Ceresa
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Venkatesha Udupa
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Zahir Soonawalla
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Michael A Silva
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Alex Gordon-Weeks
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Srikanth Reddy
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
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Eltoum A, O'Reilly D, Yousif TI. Virtual clinics progress and outcome during the Covid-19 pandemic. Ir J Med Sci 2023; 192:219-220. [PMID: 35301667 PMCID: PMC8929710 DOI: 10.1007/s11845-022-02977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
AIM To assess progress and outcome of the Virtual clinics during the Covid-19 Pandemic. METHODS We used Excel sheet to collect and anlyse data including number of call attempts for answer, duration of the calls, success in talking to the carers and the outcome of consulttion. RESULTS One-hundred-sixty-seven calls were made for 117 patients. Average of 1.3 calls per patient. 94/115 (81.7%) calls were eventually answered. 65% (71) parents answered the call from a single attempt (71/110). 18% (21/110) of parents answered the call on the second attempt. The average call duration was 9 min (range 21-5 min). We discharged 11% (11/103) of patients, while 33% (34/103) patients required a face-to-face physical review. A follow-up appointment was scheduled for 54% patients (58/103). DISCUSSION/CONCLUSION With careful patients' selection, virtual outpatient clinics represent a feasible means of delivering outpatient care from a clinician perspective.
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Affiliation(s)
- Ali Eltoum
- Department of Paediatrics, Regional Hospital Mullingar, Longford Road, MullingarDublin, Westmeath, Ireland
| | - Daniel O'Reilly
- Department of Paediatrics, Regional Hospital Mullingar, Longford Road, MullingarDublin, Westmeath, Ireland
| | - Taha I Yousif
- Department of Paediatrics, Regional Hospital Mullingar, Longford Road, MullingarDublin, Westmeath, Ireland.
- RCSI, Dublin, Ireland.
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Lee G, Kammermeier J, Vora R, Mutalib M. Review of a paediatric inflammatory bowel disease service during the pandemic and the impact of the CNS role. ACTA ACUST UNITED AC 2021; 30:840-844. [PMID: 34288747 DOI: 10.12968/bjon.2021.30.14.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a chronic relapsing and remitting condition. The COVID-19 pandemic has severely disrupted provision of medical care across the world. IBD clinical nurse specialists (CNSs) played a pivotal role in the care of children with IBD during the pandemic national lockdown and in the recovery phase. This article aims to look at the impact of COVID-19 on the paediatric IBD service in one children's hospital and the effect on the IBD CNSs' workload. METHOD A retrospective review of clinical notes and the service's IBD database from January 2019 to September 2020. RESULTS There was a significant increase in the number of email and telephone contacts to the IBD CNS team during lockdown. There was an increase in virtual clinics, and an increase in new IBD patients coming to the service, but a reduction in the number of face-to-face consultant clinics. CONCLUSION COVID-19 has disrupted medical services to children with IBD and led to a reduction in face-to-face activities but has also led to a significant increase in virtual activities. CNSs have taken up a wider role to cover patient care during a time of both medical and nursing redeployment.
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Affiliation(s)
- Gemma Lee
- Clinical Nurse Specialist, Paediatric Gastroenterology Department, Evelina London Children's Hospital, London
| | - Jochen Kammermeier
- Consultant Paediatric Gastroenterologist, Paediatric Gastroenterology Department, Evelina London Children's Hospital, London
| | - Rakesh Vora
- Consultant Paediatric Gastroenterologist, Paediatric Gastroenterology Department, Evelina London Children's Hospital, London
| | - Mohamed Mutalib
- Consultant Paediatric Gastroenterologist, Paediatric Gastroenterology Department, Evelina London Children's Hospital, London
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Stanley C, Kelly M, Elzaki M, Butler A, Condon F, Lenehan B. Lessons from lockdown: Virtual Clinics and service reorganisation in fracture management during COVID 19 experience of an Irish Regional Trauma Unit. Surgeon 2021; 19:e325-e330. [PMID: 33775562 PMCID: PMC7931677 DOI: 10.1016/j.surge.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/18/2020] [Accepted: 02/09/2021] [Indexed: 12/03/2022]
Abstract
Background Trauma places a burden on healthcare services accounting for a large proportion of Emergency Department presentations. COVID-19 spread rapidly affecting over 30 million worldwide. To manage trauma presentations the Department of Trauma & Orthopaedic Surgery reorganised service delivery. Aim To assess the impact of service reorganisation and Virtual Clinics on patients in a Regional Unit in Ireland. Methods A retrospective review of trauma activity following introduction of Virtual Fracture Clinics and Theatre COVID Pathways for a 10 week period in comparison with the same 2019 period. All patients underwent both nasopharyngeal and oropharyngeal swabs PCR testing prior to operations. Theatre and outpatient activity were evaluated. Clinic data were accumulated using the Integrated Patient Management System. Results Theatre Activity: 242 patients underwent surgery in our trauma unit (mean 2.98 per list) during the COVID- 19 period. 29 cases were performed in repurposed elective hospital giving a total of 271 during the 2020 study period. 371 cases were performed in the same 2019 period (mean 4.58 per list). Outpatient Activity: We noted a 25.86% fracture clinic referral reduction during the COVID 19 period compared to 2019. There was a 150.77% increase in patients managed through Trauma Assessment Clinic. 639 patients were managed through the Virtual Fracture Clinic Pathway during COVID 19 period. Conclusions Over one in four fracture clinic patients can be managed virtually. A new dedicated Acute Fracture Unit within our institution permitted streamlining of care and social distancing. The “Non-COVID” pathway for ambulatory trauma was essential in managing the growing presentations of these injuries.
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Affiliation(s)
- Ciaran Stanley
- Department of Orthopaedics, University Hospital Limerick, Ireland.
| | - Martin Kelly
- Department of Orthopaedics, University Hospital Limerick, Ireland.
| | - Mohamed Elzaki
- Department of Orthopaedics, University Hospital Limerick, Ireland.
| | - Audrey Butler
- Department of Orthopaedics, University Hospital Limerick, Ireland.
| | - Finbarr Condon
- Department of Orthopaedics, University Hospital Limerick, Ireland.
| | - Brian Lenehan
- Department of Orthopaedics, University Hospital Limerick, Ireland.
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O'Reilly D, Carroll H, Lucas M, Sui J, Al Sendi M, McMahon D, Darwish W, McLaughlin R, Khan MR, Sullivan HO, Chew S, Dennehy C, Kelly CM, McCaffrey J, Greally M, Carney D, Higgins MJ. Virtual oncology clinics during the COVID-19 pandemic. Ir J Med Sci 2021; 190:1295-1301. [PMID: 33449331 PMCID: PMC7809230 DOI: 10.1007/s11845-020-02489-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/17/2020] [Indexed: 02/08/2023]
Abstract
Background The COVID-19 pandemic has resulted in radical changes in the delivery of healthcare worldwide. Our oncology service (at an Irish national cancer centre) rapidly transitioned to the use of telemedicine or virtual clinics (VC) to minimise potential risk of exposure to COVID-19 amongst an immunosuppressed, high-risk population. Our study aimed to evaluate the use of VC in this setting. Methods An 18-point questionnaire was designed to investigate the patient experience of VC during the COVID-19 pandemic in Ireland and compliance with guidelines developed in Ireland to conduct VC and the role of VC in the future. Questionnaires were distributed following the receipt of verbal consent from patients during the VC. Descriptive statistics were utilised for data analysis using SPSS®. Results One hundred and four patients returned completed surveys (n = 104/164, 63% response rate). Overall satisfaction levels were high with most patients (n = 58/100, 58%; no answer provided (NAP), n = 4) equally satisfied or nearly equally satisfied with VC in comparison to a usual clinic encounter. The majority of patients felt that there should be a role for VC in the future (n = 84/102, 82%; NAP, n = 2). The majority of patients (n = 61/99, 61%; NAP, n = 5) were very relieved to avoid a hospital visit due to perceived risk of potential exposure to COVID-19. Conclusion The majority of oncology patients were satisfied with a VC encounter. VC may have a role in the future of medical care in Ireland post the COVID-19 pandemic.
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Affiliation(s)
- David O'Reilly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland.
| | - Hailey Carroll
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Mairi Lucas
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Jane Sui
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Maha Al Sendi
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - David McMahon
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Waseem Darwish
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Ronan McLaughlin
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Mohammed Raza Khan
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Hazel O Sullivan
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Sonya Chew
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Colum Dennehy
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Catherine M Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - John McCaffrey
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Megan Greally
- Department of Medical Oncology, Mater Private Hospital, Eccles Street, Dublin, 7, Ireland
| | - Desmond Carney
- Department of Medical Oncology, Mater Private Hospital, Eccles Street, Dublin, 7, Ireland
| | - Michaela J Higgins
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
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Hintze JM, O'Riordan I, Hussain T, Keane E, Casserly P. Differences in patient satisfaction with virtual telephone clinics in a tertiary referral centre for otolaryngology during and after lockdown measures during the SARS-Cov2 pandemic. Ir J Med Sci 2021; 190:1349-1353. [PMID: 33439412 PMCID: PMC7803877 DOI: 10.1007/s11845-020-02483-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
Abstract
Introduction The SARS-Cov2 pandemic has caused considerable disruption to provision of routine outpatient care. This pandemic has necessitated a more modern and innovative approach to clinics, which could potentially change outpatient organisation and improve efficiency in the long term. Telephone clinics are the most practical way to deliver healthcare at a distance. Aim The purpose of the present study was to assess patient satisfaction with a virtual telephone clinic in a tertiary referral centre for otolaryngology first during the height of the SARS-Cov2 pandemic, and subsequently at a physical follow-up appointment after easing of “lockdown” measures. Methods Patients were enrolled prospectively via a telephone interview over a 1-week period during the height of the “lockdown” measures, and subsequently at a physical appointment when measures eased. Results Overall, patients responded very positively in the anonymised questionnaire at the time of their virtual appointment. However, at a subsequent physical appointment, there was a reduction in overall favourable responses from patients. While patients still thought virtual clinics were a good idea and convenient in the context of SARS-Cov2, we noted a reduction in satisfaction in other key aspects of their care. Notably, patients were less likely to think that virtual clinics were able to properly address their condition. Conclusion While virtual clinics remain a useful tool during the height of lockdown measures during the SARS-Cov2 pandemic, we did note a significant reduction in favourable responses to virtual appointments over physical ones upon easing of lockdown measures. Patients remained cautious in suggesting that outpatient appointments may be replaced by virtual clinics.
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Affiliation(s)
- Justin M Hintze
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
- Royal College of Surgeons in Ireland, Dublin, Ireland.
- Trinity College Dublin, The University of Dublin, Dublin, Ireland.
| | - Isobel O'Riordan
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Tanvir Hussain
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Emma Keane
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Paula Casserly
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Dunkerley S, Thelwall C, Omiawele J, Smith A, Deo S, Lowdon I. Patient care modifications and hospital regulations during the COVID-19 crisis created inequality and functional hazard for patients with orthopaedic trauma. Int Orthop 2020; 44:2481-2485. [PMID: 32767088 PMCID: PMC7412999 DOI: 10.1007/s00264-020-04764-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE The COVID pandemic has decreased orthopaedic fracture operative intervention and follow-up and increased the use of virtual telemedicine clinics. We assessed the implications of this management on future orthopaedic practice. We also surveyed patient satisfaction of our virtual fracture follow-up clinics. METHOD We prospectively analysed 154 patients during two weeks of 'lockdown' assessing their management. We surveyed 100 virtual fracture clinic follow-up patients for satisfaction, time off work and travel. RESULTS Forty-nine percent of patients had decisions affected by COVID. Twelve percent of patients were discharged at diagnosis having potentially unstable fractures. These were all upper limb fractures which may go onto mal-union. Twenty-nine percent of patients were discharged who would have normally had clinal or radiological follow-up. No patients had any long-term union follow-up. Virtual telemedicine clinics have been incredibly successful. The average satisfaction was 4.8/5. In only 6% of cases, the clinician felt a further face-to-face evaluation was required. Eighty-nine percent of patients would have chosen virtual follow-up under normal conditions. CONCLUSION Lessons for the future include potentially large numbers of upper limb mal-unions which may be symptomatic. The non-union rate is likely to be the same, but these patients are unknown due to lack of late imaging. Telemedicine certainly has a role in future orthopaedic management as it is well tolerated and efficient and provides economic and environmental benefits to both clinicians and patients.
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Affiliation(s)
- Sarah Dunkerley
- Great Western Hospitals NHS Foundation Trust, Malborough Road, Swindon, SN3 6BB, UK.
| | - Claire Thelwall
- Great Western Hospitals NHS Foundation Trust, Malborough Road, Swindon, SN3 6BB, UK
| | - Joshua Omiawele
- Great Western Hospitals NHS Foundation Trust, Malborough Road, Swindon, SN3 6BB, UK
| | - Adam Smith
- Great Western Hospitals NHS Foundation Trust, Malborough Road, Swindon, SN3 6BB, UK
| | - Sunny Deo
- Great Western Hospitals NHS Foundation Trust, Malborough Road, Swindon, SN3 6BB, UK
| | - Ian Lowdon
- Great Western Hospitals NHS Foundation Trust, Malborough Road, Swindon, SN3 6BB, UK
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Ferdinandus S, Smith LK, Pandit H, Stone MH. Setting up an arthroplasty care practitioner-led virtual clinic for follow-up of orthopaedic patients. ACTA ACUST UNITED AC 2020; 28:1326-1330. [PMID: 31714821 DOI: 10.12968/bjon.2019.28.20.1326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article provides an overview of the set up for an arthroplasty care practitioner (ACP)-led virtual orthopaedic clinic (VOC). Suitable patients attend a local hospital for an X-ray and complete a questionnaire, but do not physically attend a clinic. This has been running successfully in a university teaching hospital and has led to cost savings, a reduction in outpatient waiting times and high levels of patient satisfaction. Similar clinics have the potential to become normal practice across the NHS. This article outlines the steps necessary to implement a successful VOC. The lessons learnt during this exercise may be useful for other ACPs when setting up a VOC.
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Affiliation(s)
- Sharon Ferdinandus
- Orthopaedic Nurse Specialist, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust
| | - Lindsay K Smith
- Visiting Professor and Senior Lecturer, Faculty of Health and Applied Science, University of the West of England, Bristol and Arthroplasty Practitioner/Advanced Physiotherapist, Orthopaedic Department, Weston General Hospital, Weston-super-Mare
| | - Hemant Pandit
- Honorary Consultant Orthopaedic Surgeon, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; and Professor of Orthopaedic Surgery, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
| | - Martin H Stone
- Consultant Orthopaedic Surgeon, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust; and Honorary Clinical Associate Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
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Abstract
Background Advances in the management of retinal diseases have been fast-paced as new treatments become available, resulting in increasing numbers of patients receiving treatment in hospital retinal services. These patients require frequent and long-term follow-up and repeated treatments, resulting in increased pressure on clinical workloads. Due to limited clinic capacity, many National Health Service (NHS) clinics are failing to maintain recommended follow-up intervals for patients receiving care. As such, clear and robust, long term retinal service models are required to assess and respond to the needs of local populations, both currently and in the future. Methods A discrete event simulation (DES) tool was developed to facilitate the improvement of retinal services by identifying efficiencies and cost savings within the pathway of care. For a mid-size hospital in England serving a population of over 500,000, we used 36 months of patient level data in conjunction with statistical forecasting and simulation to predict the impact of making changes within the service. Results A simulation of increased demand and a potential solution of the ‘Treat and Extend’ (T&E) regimen which is reported to result in better outcomes, in combination with virtual clinics which improve quality, effectiveness and productivity and thus increase capacity is presented. Without the virtual clinic, where T&E is implemented along with the current service, we notice a sharp increase in the number of follow-ups, number of Anti-VEGF injections, and utilisation of resources. In the case of combining T&E with virtual clinics, there is a negligible (almost 0%) impact on utilisation of resources. Conclusions Expansion of services to accommodate increasing number of patients seen and treated in retinal services is feasible with service re-organisation. It is inevitable that some form of initial investment is required to implement service expansion through T&E and virtual clinics. However, modelling with DES indicates that such investment is outweighed by cost reductions in the long term as more patients receive optimal treatment and retain vision with better outcomes. The model also shows that the service will experience an average of 10% increase in surplus capacity. Electronic supplementary material The online version of this article (10.1186/s12913-018-3560-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eren Demir
- University of Hertfordshire, Hertfordshire Business School, Hertfordshire, UK. .,Pathway Communications Ltd, Cambridge, UK.
| | | | - Aimee Verner
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Winfried Amoaku
- Academic Ophthalmology, DCN, Faculty of Medicine, The University of Nottingham, Nottingham, UK
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