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We read the report by Gilbert et al on the rapid implementation of virtual clinics in reponse to COVID-19, with particular interest into the high satisfaction scores given by patients and clinicians into the use of virtual clinics.
We conducted a retrospective patient feedback survey at Brighton at Sussex University Hospital looking at patient feedback on the use of Virtual Clinics as an alternative to face to face clinic appointments in General Surgery during the COVID-19 pandemic. We found that virtual clinics are well accepted by patients and should continue to be utilised post COVID-19 forming part of integrated care pathways in outpatient care.
The use of Virtual clinics are novel to the department and were implemented as a consequence of the social distancing measures introduced to stop the spread of coronavirus during the COVID-19 pandemic. We identified the need to seek feedback from the patients attending these clinics, recognising that patient opinion is invaluable to the development and sustainability of services.
Over 100 patients were contacted asking them to fill out an online survey, patients who did not have an email address were asked if they wanted to complete a shorted survey over the telephone; 73 patients responded across both surveys.
Data collected suggests that virtual clinics are well received by patients. 77.8% (n=42) reported that they had no problems accessing the virtual clinic. 87.7% (n=64) of patients reported...
Data collected suggests that virtual clinics are well received by patients. 77.8% (n=42) reported that they had no problems accessing the virtual clinic. 87.7% (n=64) of patients reported that they saved time and 65.8% (n=48) answered that they had made a financial saving by attending the virtual clinic. 48% (n=35) answered that they were overall ‘very satisfied’ with the care received in the virtual clinic, and 79.6% (n=43) felt that their care did not suffer as a result of non-face to face contact.
The majority of patients would recommend a virtual clinic to their friend or family 77% (n=56), however if given the option 60% (n=43) would prefer a face to face clinic appointment. This may suggest that whilst accepting of virtual clinics, patients may be reassured if they could access a face to face consultation if necessary. This gives scope for the use of such clinics as part of an integrated care pathway, perhaps for use as follow up or in triage.
As the pandemic progresses it is important to identify ways in which good patient care can be delivered whilst not putting patients at risk of contracting the virus. Virtual clinics not only maintain patient safety but also cause less disruption to patients’ lives with quantifiable savings in both time and money as demonstrated in the feedback received. With the relaxing of social distancing measures, now is a good time to reflect on the changes made during the pandemic to assess if any should remain. This study suggests that the use of virtual clinics should continue and could be utilised to provide efficient patient centred care without compromising the quality of care delivered.
We read with interest the RNOH report regarding rapid implementation of virtual clinics due to Covid-19 (Gilbert et al, BMJ Open, 21 May 2020). The Royal Free Child and Adolescent Eating Disorder Service (RF-EDS) has similarly been required to adapt the service rapidly during the Covid-19 crisis, such that 95% of our patients have been treated by telephone or videoconferencing.
The clinical needs of our patients to receive evidence-based treatment, needed to be balanced with the risks of Covid infection. Eating disorders have the highest mortality of all psychiatric disorders and early treatment has been shown to improve outcomes. Treatment is usually outpatient care with a minority requiring short hospital admissions for medical stabilisation. The RF-EDS has a day service, which has managed higher risk patients in the community as paediatric wards in North Central London have closed/relocated during the pandemic.
Since the pandemic, all routine treatment to current patients has been via video or telephone, with high-risk patients continuing face-to-face care (socially distanced or with PPE). This can be stepped-up to prevent hospital admission. Meal support, a weekly parent support group and drop-in clinic have been set up to run via videoconference.
From 23/03/20 to 01/05/20, the number of new referrals to the service was similar to the same period in 2019 (19). The number of outpatient contacts was 731 and 96% of these were treated in virtual cli...
From 23/03/20 to 01/05/20, the number of new referrals to the service was similar to the same period in 2019 (19). The number of outpatient contacts was 731 and 96% of these were treated in virtual clinics. There were 697 patient contacts during the same period in 2019. The day service provided a total of 338 patient contacts, 48% via remote working.
There has been positive feedback from families who have welcomed the flexibility of remote treatment and the reduced need to travel. Some young people have reported that they are happier not to sit in a waiting room with other patients and take time out from education. Clinicians have found home working has improved efficiency. Daily team videoconferencing has maintained multi-disciplinary working with team meetings and supervision continuing remotely. There has been an increase in collaborative work with other community mental health teams through videoconferencing.
The main challenges have been developing rapport with new patients via videoconferencing and to gather information from non-verbal cues or family interactions, particularly when family members are required to face the camera. Engagement is a key aspect of treatment and there are concerns that safeguarding risks may be missed. Individual sessions can be hindered by lack of privacy and reluctance to be open about difficulties. Young people who are struggling with their appearance dislike seeing themselves on camera and it has been difficult for patients who prefer non-verbal aids to express themselves. Risk assessment of patients with serious mental health symptoms has not been considered safe enough to do remotely. In addition, there have been on-going challenges with the video platforms used.
Our view is that virtual clinics have so far been effective in providing routine treatments and have improved efficiency. Going forward, we would collaborate with service-users to decide how much treatment should continue virtually.