Telemedicine for ENT: Effect on quality of care during Covid-19 pandemic

COVID-19 and Speech-Language Pathology Clinical Practice of Voice and Upper Airway Disorders

Purpose Evaluation and management of voice and upper airway disorders in adults and children, by speech-language pathologists worldwide, have been significantly altered by the COVID-19 pandemic. Secondary to the pathogenic nature of the virus in the respiratory tract and upper airway, it is essential that speech-language pathologists who specialize in these disorders are knowledgeable of current practices to provide evidence-based care while minimizing viral transmission. Understanding how and when SARS-CoV-2 spreads is critical to the development of effective infection prevention within clinical practices. Method We established an evidence-based clinical practice guide for clinicians working with voice and upper airway through a comprehensive evaluation of peer-reviewed journals, non-peer-reviewed manuscripts on preprint servers, national health guidelines, and published and online consensus statements and emerging data. Emphasis was placed on risk mitigation for viral transmission via safe clinical practices, including evaluative procedures, therapy including telehealth, personal protective equipment, room, staffing, and distancing considerations. Results/Conclusions While knowledge relevant to viral transmission of SARS-CoV-2 is rapidly evolving, there is a paucity of literature specific to the evaluation and treatment of voice and upper airway disorders. Within these confines and given the potentially significant high risk of infection secondary to the nature of COVID-19, we summarize current considerations and recommend best practices that maximize risk mitigation whereby ensuring patient and provider safety.

Improving clinical practice in ENT: Lessons learnt from the COVID-19 pandemic

During the COVID‐19 pandemic, the ENT community has demonstrated strong clinical leadership, adaptability to rapid change, enhanced clinical pathways and local networks, widespread use of digital technology for consultation and teaching and redirection of research programmes. These have permanently changed the way we work and, when the current global pandemic improves as COVID‐19 infections drop and vaccination programmes are rolled out, we should ensure that the positive changes that have been made are embedded in clinical practice to improve patient care.

Telemedicine visits in an established multidisciplinary central nervous system clinic for radiation oncology and neurosurgery (RADIANS) in a community hospital setting

OBJECTIVE

To determine the impact of telemedicine visits, compared to in-person visits, on patient satisfaction in an established community hospital-based multidisciplinary central nervous system (CNS) clinic.

METHODS

Telemedicine options - virtual visits and teleconferencing - were introduced in July 2020. Both radiation oncologist and neurosurgeon were simultaneously present for the telemedicine visit. Descriptive patient demographics, survey responses, and travel time and distance calculations were analyzed. Satisfaction score was compared to previously published data.

RESULTS

A total of twenty-five telemedicine visits (n=22 video; n=3 phone) were completed since July 2020. Patient demographics are as follows: mean age was 59 years (range=22-81), women (9) and men (16), repeat telemedicine visits n=10, malignant CNS disease (17) and benign disease (5). Mean one-way distance traveled was 165.07 miles (median=114; range=0.8-358). Mean roundtrip travel time was estimated at 5h 5min. Mean telemedicine visit duration was 15.3 mins (range=4-46). Mean patient satisfaction score for telemedicine visits was 4.84.

CONCLUSION

Patients who opted for the telemedicine visits found them just as effective as in-person visits, saving time and travel costs as well as ensuring patient safety during the current COVID-19 pandemic. The telemedicine visit platform facilitates the multidisciplinary clinic model and should be considered for more widespread utilization (Tab. 3, Fig. 1, Ref. 18).

Otology practice during COVID-19 era: a review of current practice

Background

The novel coronavirus started as an outbreak in Wuhan, China, in December 2019.The outbreak was declared a pandemic by the WHO on 12 March 2020. The virus is called SARS-CoV-2, and the virus-induced disease is called COVID-19. The infection spreads via droplets or direct contact with contaminated surfaces. Airborne transmission occurs during aerosol-generating procedures on patients. Many otologic procedures are considered AGPs and therefore require precautions to protect staff and patients and minimize transmission of the disease.

Main body

Outpatient otology activity has seen changes, including virtual clinics and limitation of face-to-face consultations, to ensure safety. Powered instrumentation should be avoided during surgical procedures unless necessary or replaced with other tools, and if performed, enhanced personal protective equipment (PPE) must be used. Ear, nose, and throat (ENT) examination is recommended for any patient with full PPE in place except for consultations done without examination. Systemic steroid administration for treating conditions such as Bell’s palsy and sudden sensorineural hearing loss should be discussed with both the patient and infectious diseases specialist to weigh risks against benefits. Triaging of patients and prioritization is unavoidable during the pandemic and even after due to the limitations of clinic and theater time. All emergency/urgent cases are considered potentially COVID-19 positive. For the semi-urgent and all elective cases, COVID-19 testing 48 h prior to surgery, strict quarantine awaiting test results, and repeat testing on day of surgery if rapid tests are available are the precautions suggested. Different measures should be in place to minimize staff potential exposure intraoperatively.

Conclusions

Otology practice has been affected by the COVID-19 pandemic. Various measures are in place to ensure the delivery of safe and effective service for patients and health care workers.

Telemedicine in Audiology. Best practice recommendations from the French Society of Audiology (SFA) and the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL)

Objectives

Access to diagnosis and treatments for auditory disorders and related pathologies has regressed in France during the COVID-19 pandemic, posing a risk to the patient's chance of recovery. This best practice recommendations guide aims to list the existing technological solutions for the remote examination of a patient with hearing complaint, and to outline their benefits and, where applicable, their limitations.

Methods

The recommendations were developed both from the clinical experience of the medical experts who drafted the guide, and from an extensive review of the literature dealing with clinical practice recommendations for tele-audiology. Tele-audiometry solutions were identified on the basis of a search engine query carried out in April 2020, prior to verification of their availability on the European market.

Results

Video otoscopy solutions allow for the teletransmission of images compatible with a high-quality diagnosis, either by connecting via internet to a tele-health platform or using a smartphone or a tablet with an iOS or Android operating system. Using the same telecommunication methods, it is possible to remotely conduct a pure-tone audiometry test in accordance with standard practice, a speech-in-quiet or a speech-in-noise audiometry test, as well as objective measures of hearing. Clinical and paraclinical examinations can be accessed by the physician to be interpreted on a deferred basis (asynchronous tele-audiology). Examinations can also be conducted in real time in a patient, at any age of life, as long as a caregiver can be present during the installation of the transducers or the acoumetry. Tele-audiology solutions also find application in the remote training of future healthcare professionals involved in the management of deafness and hearing impairment.

Conclusion

Under French law, tele-otoscopy is a medical procedure that is either a tele-expertise (asynchronous adive) or a teleconsultation act (synchronous advice). Subjective and objective evaluation of the patient's hearing functions can be done remotely provided that the listed precautions are respected.

Satisfaction with the use of telehealth during COVID-19: An integrative review

Background

The novel coronavirus (COVID-19) pandemic has defined 2020 thus far. Businesses, social and religious gatherings, travel, and almost all forms of transportation shut down to halt the spread of COVID-19. People were ordered to quarantine in place, and the world appears to go into a standstill. In the midst of being quarantined people with acute and chronic conditions still require medical care and treatment. An alternative way for people to receive needed health care was necessary. Hence, we saw an unprecedented surge in telehealth. With this unprecedented surge in use of telehealth, there is matter of delivering quality care.

Objective

Guided by the Donabedian Model, the purpose of this integrative review was to examine current evidence on patient and healthcare provider's satisfaction with the use of telehealth during the COVID-19 pandemic.

Design

An integrative review of the literature.

Data sources

The literature review was conducted utilizing PubMED, CINAHL, Google Scholar and Cochrane Library databases. Inclusion criteria were studies published from January 2020 to July 11, 2020, published and translated in English language, and studies that evaluated patients and providers satisfaction with the use of telehealth or telemedicine during COVID-19. Eighteen articles were included in this review.

Review methods

An evaluation matrix was developed to collect data from the included articles. The articles were appraised using Fineout-Overholt & Gallagher-Ford Rapid Critical Appraisal Checklist for Descriptive Studies and Rapid Critical Appraisal of Evidence-Based Practice Implementation or Quality Improvement Projects (Melnyk & Fineout-Overholt, 2015). Authors independently appraised each article using the appropriate appraisal tools.

Results

Ten of the articles (53%) included were studies conducted in the United States. Sixteen out of 18 studies evaluated patient satisfaction and five studies examined healthcare providers' satisfaction with the use of telehealth. The majority of telehealth services offered were by subspecialists. Overall, patients and healthcare providers have high level of satisfaction with the use of telehealth during COVID-19 pandemic. Many patients and healthcare providers reported willingness to continue using telehealth after the pandemic.

Conclusion

This integrative review provided additional evidence on patient and healthcare provider's satisfaction with the use of telehealth. Findings in this review may not be surprising as individuals, healthcare providers, and health systems needed to adopt the use telehealth due to necessity. However, the results for telehealth are promising.