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Rostron H, Wright JM, Gilbert AW, Dillon B, Pini S, Redmond AC, Livermore P. Adoption of technology enabled care to support the management of children and teenagers in rheumatology services: a protocol for a mixed-methods systematic review. BMJ Open 2024; 14:e082515. [PMID: 38387983 PMCID: PMC10882409 DOI: 10.1136/bmjopen-2023-082515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION COVID-19 catalysed a rapid move to provide care away from the hospital using online communication platforms. Technology enabled care (TEC) continues to be an important driver in progressing future healthcare services. Due to the complex and chronic nature of conditions seen within paediatric rheumatology, TEC may lead to better outcomes. Despite some growth in published literature into the adoption of TEC in paediatric rheumatology, there is limited synthesis. The aim of this review is to provide a comprehensive understanding and evaluation of the adoption of TEC by patients in paediatric rheumatology services, to establish best practices. METHODS AND ANALYSIS This proposed mixed-methods systematic review will be conducted by searching a wide variety of healthcare databases, grey literature resources and associated charities and societies, for articles reported in English language. Data extraction will include population demographics, technology intervention, factors affecting adoption of intervention and consequent study outcomes. A parallel-results convergent synthesis design is planned, with independent syntheses of quantitative and qualitative data, followed by comparison of the findings of each synthesis using a narrative approach. Normalisation process theory will be used to identify, characterise and explain implementation factors. The quality of included articles will be assessed using the Mixed Methods Appraisal Tool for research papers and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for grey literature. Overall confidence in quality and strength of evidence will be assessed using the Confidence in the Evidence from Reviews of Qualitative Research tool. ETHICS AND DISSEMINATION Ethical approval is not required due to the nature of this mixed-methods systematic review. The findings will be disseminated via a peer-reviewed journal, relevant conferences and any other methods (eg, via NHS Trust or NIHR YouTube channels) as advised by paediatric rheumatology patients. PROSPERO REGISTRATION NUMBER CRD42023443058.
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Affiliation(s)
- Heather Rostron
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Children's Research Team, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Simon Pini
- Psychological and Social Medicine, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Polly Livermore
- Infection, Immunity & Inflammation Department, University College London, London, UK
- NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Haveman ME, Jonker LT, Hermens HJ, Tabak M, de Vries JPP. Effectiveness of current perioperative telemonitoring on postoperative outcome in patients undergoing major abdominal surgery: A systematic review of controlled trials. J Telemed Telecare 2024; 30:215-229. [PMID: 34723689 DOI: 10.1177/1357633x211047710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Perioperative telemonitoring of patients undergoing major surgery might lead to improved postoperative outcomes. The aim of this systematic review is to evaluate the effectiveness of current perioperative telemonitoring interventions on postoperative clinical, patient-reported, and financial outcome measures in patients undergoing major surgery. METHODS For this systematic review, PubMed, CINAHL, and Embase databases were searched for eligible articles published between January 1, 2009 and March 15, 2021. Studies were eligible as they described: (P) patients aged 18 years or older who underwent major abdominal surgery, (I) perioperative telemonitoring as intervention, (C) a control group receiving usual care, (O) any type of postoperative clinical, patient-reported, or financial outcome measures, and (S) an interventional study design. RESULTS The search identified 2958 articles of which 10 were eligible for analysis, describing nine controlled trials of 2438 patients. Perioperative telemonitoring comprised wearable biosensors (n = 3), websites (n = 3), e-mail (n = 1), and mobile applications (n = 2). Outcome measures were clinical (n = 8), patient-reported (n = 5), and financial (n = 2). Results show significant improvement of recovery time, stoma self-efficacy and pain in the early postoperative phase in patients receiving telemonitoring. Other outcome measures were not significantly different between the groups. CONCLUSION Evidence for the effectiveness of perioperative telemonitoring in major surgery is scarce. There is a need for good quality studies with sufficient patients while ensuring that the quality and usability of the technology and the adoption in care processes are optimal.
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Affiliation(s)
- Marjolein E Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Leonie T Jonker
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, the Netherlands
- eHealth group, Roessingh Research and Development, the Netherlands
| | - Monique Tabak
- Department of Biomedical Signals and Systems, University of Twente, the Netherlands
- eHealth group, Roessingh Research and Development, the Netherlands
| | - Jean-Paul Pm de Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
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Abed H, Samson D, David M. Early Discharge and Patient-Initiated Follow-Up in Hand Surgery: A New Norm Following Simple Hand Surgery? Cureus 2024; 16:e52493. [PMID: 38371052 PMCID: PMC10874133 DOI: 10.7759/cureus.52493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
AIMS The demand for elective hand surgery has increased substantially over the last 10 years. With COVID-19 providing an added challenge of restrictions on face-to-face consultations, already overflowing follow-up clinics will be stressed further. Our aim is to assess the viability, effectiveness, and safety of an early discharge directly from the operating theatre following common hand surgery procedures with the safety net of open-access follow-up. METHODS All eligible patients undergoing open-hand surgery under local anaesthesia between February 2019 and December 2020 were offered early discharge. Informed consent was obtained in the clinic, and they were counselled on rehabilitation immediately prior to surgery. Patients were given a custom-made "open-access business card" with clear post-operative instructions and hand exercises, along with information on how to get in touch to request clinic follow-up. A review was completed at a minimum of two months following surgery. Administrative support staff were briefed beforehand to minimise any delays in follow-up requests and either book patients who requested follow-up into a routine elective clinic or utilise ring-fenced emergency elective clinic slots depending on the patient's individual requirements. RESULTS A total of 105 patients were included in this study, with an average age of 60 years. The average interval between surgery and review was 20 weeks. Eighty-nine patients had a successful early discharge, with 16 patients requesting clinic follow-up. The average time to follow up in the clinic was 35 weeks (range: four to 84 weeks). There were no complications that we were made aware of, and the most common reason for returning to the clinic was a new complaint, unrelated to the surgery. CONCLUSIONS Although virtual follow-up is now well established in both the fracture and elective clinic settings, early discharge is largely uncharted water. Our pilot demonstrates that early discharge and patient-initiated follow-up for common elective hand surgical procedures under local anaesthesia are efficient, safe, and viable.
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Affiliation(s)
- Haneen Abed
- Plastic Surgery, University Hospitals Coventry and Warwickshire, Coventry, GBR
| | - Deepak Samson
- Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, GBR
| | - Michael David
- Orthopaedic Surgery, Univeristy Hospitals Coventry and Warwickshire, Coventry , GBR
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Deboever N, Eisenberg M, Hofstetter WL, Mehran RJ, Rice DC, Roth J, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Antonoff MB, Rajaram R. Financial Toxicity in Patients With Resected Lung Cancer. Ann Surg 2023; 278:1038-1044. [PMID: 37249193 DOI: 10.1097/sla.0000000000005926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To describe financial toxicity (FT) in patients with resected lung cancer and identify risk factors in this population. BACKGROUND FT describes the financial burden associated with cancer care and its impact on the quality of survivorship. Few prior studies have examined FT in patients with lung cancer. METHODS Patients who underwent lung cancer resection at our institution between January 1, 2016 and December 31, 2021, were surveyed to gather demographic information and evaluate FT using a validated questionnaire. A multivariable model was built to identify risk factors for FT. RESULTS Of the total, 1477 patients were contacted, of whom 463 responded (31.3%). Most patients were stage I (n = 349, 75.4%) and lobectomy was performed often (n = 290, 62.8%). There were 196 patients (42.3%) who experienced FT. Upon multivariable analyses, divorced marital status [odds ratio (OR) = 3.658, 95% CI: 1.180-11.337], household income <$40,000 (OR = 2.544, 95% CI: 1.003-6.455), credit score below 739 (OR = 2.744, 95% CI: 1.326-5.679), clinical stage >I (OR = 2.053, 95% CI: 1.088-3.877), and change in work hours or work cessation (all P < 0.05) were associated with FT. Coping mechanisms, such as decreased spending on food or clothing and increased use of savings or borrowing money, were more likely to be reported by patients experiencing FT than those who did not ( P < 0.001). CONCLUSIONS Patients undergoing lung cancer resection often experienced significant financial stress with several identifiable risk factors. FT should be considered early in the care of these patients to alleviate detrimental coping mechanisms and enhance their quality of survivorship.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
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Tell A, Westenhöfer J, Harth V, Mache S. Stressors, Resources, and Strain Associated with Digitization Processes of Medical Staff Working in Neurosurgical and Vascular Surgical Hospital Wards: A Multimethod Study. Healthcare (Basel) 2023; 11:1988. [PMID: 37510429 PMCID: PMC10379129 DOI: 10.3390/healthcare11141988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
The digitization of German hospitals is proceeding continuously, leading to the implementation of new digital technologies, such as electronic health records (EHRs) or other technologies, used for the purpose of medical documentation tasks. Even though the replacement of paper documentation through digitized documentation in general promises to come along with plenty of benefits, the daily utilization of technologies might also lead to stresses and strains among the medical staff, eventually possibly leading to the development of different negative work and health-related outcomes. This study, therefore, aims at identifying persisting digitization-associated stressors and resources among medical hospital staff, examining their influences on different work and health-related outcomes, and finally, identifying potential needs for preventive measures. A quantitative study in the form of an online questionnaire survey was conducted among physicians working in the medical field of neuro- and vascular surgery in German hospitals. The study was carried out between June and October 2022 utilizing an online questionnaire based on several standardized scales, such as the technology acceptance model (TAM) and the technostress model, as well as on several scales from the Copenhagen Psychosocial Questionnaire (COPSOQ). The study found medium levels of technostress among the participating physicians (n = 114), as well as low to medium levels of persisting resources. The queried physicians, on average, reported low levels of burnout symptoms, generally described their health status as good, and were mostly satisfied with their job. Despite the prevalence of technostress and the low levels of resources among the surveyed physicians, there is little awareness of the problem of digital stress, and preventive measures have not been widely implemented yet in the clinics, indicating a needs gap and the necessity for the strategic and quality-guided implementation of measures to effectively prevent digital stress from developing.
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Affiliation(s)
- Anika Tell
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, 20459 Hamburg, Germany
| | - Joachim Westenhöfer
- Department Health Sciences, Faculty of Life Sciences, University of Applied Sciences (HAW), Ulmenliet 20, 21033 Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, 20459 Hamburg, Germany
| | - Stefanie Mache
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, 20459 Hamburg, Germany
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Francheska BK, Lee R, Oni G, Wilson E. Patients' experience of teleconsultations in the UK. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S24-S29. [PMID: 37219975 DOI: 10.12968/bjon.2023.32.10.s24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Teleconsultations were introduced for cancer surgery follow-up to ease pressure on hospital services and facilitate patients' access to those services. There is limited evidence on patients' perceptions of this swift shift in service provision. AIMS The purpose of this qualitative systematic review was to explore patient experiences of teleconsultations within NHS cancer surgery follow-up services to better understand patient perceptions, satisfaction and acceptability of teleconsultations within cancer services. METHODS Medline, Embase, PubMed and Google Scholar were searched up to 1 July 2022. Qualitative studies were synthesised using the Braun and Clarke framework. FINDINGS There were three overarching themes: accessibility; patient experience; and consultation. CONCLUSION Teleconsultations were widely accepted among cancer surgical patients. However, there were reports of a lack of rapport building and emotional support because of the absence of visual cues and patient camaraderie.
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Affiliation(s)
| | - Rachel Lee
- General Surgery Registrar, Nottingham University Hospitals NHS Trust
| | - Georgette Oni
- Consultant Oncoplastic Breast Surgeon, Nottingham Breast Institute, Nottingham University Hospitals NHS Trust
| | - Emma Wilson
- Professor of Public Health, Nottingham Centre for Public Health and Epidemiology, University of Nottingham
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Dumbrava BD, Bass GA, Jumean A, Birido N, Corbally M, Pereira J, Biloslavo A, Zago M, Walsh TN. The Accuracy of Point-of-Care Ultrasound (POCUS) in Acute Gallbladder Disease. Diagnostics (Basel) 2023; 13:diagnostics13071248. [PMID: 37046466 PMCID: PMC10093186 DOI: 10.3390/diagnostics13071248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023] Open
Abstract
There is increasing recognition that point-of-care ultrasound (POCUS), performed by the clinician at the bedside, can be a natural extension of the clinical examination—the modern abdominal “stethoscope” and provides an opportunity to expedite the care pathway for patients with acute gallbladder disease. The primary aims of this study were to benchmark the accuracy of surgeon-performed POCUS in suspected acute gallbladder disease against standard radiology or pathology reports and to compare time to POCUS diagnosis with time to definitive imaging. This prospective single-arm observational cohort study was conducted in four hospitals in Ireland, Italy, and Portugal to assess the accuracy of POCUS against standard radiology in patients with suspected acute biliary disease (ClinicalTrials.govIdentifier: NCT02682368). The findings of surgeon-performed POCUS were compared with those on definitive imaging or surgery. Of 100 patients recruited, 89 were suitable for comparative analysis, comparing POCUS with radiological findings in 84 patients and with surgical/histological findings in five. The overall global accuracy of POCUS was 88.7% (95% CI, 80.3–94.4%), with a sensitivity of 94.7% (95% CI, 85.3–98.9%), a specificity of 78.1% (95% CI, 60.03–90.7%), a positive likelihood ratio (LR+) of 4.33 and negative likelihood ratio (LR) of 0.07. The mean time from POCUS to the final radiological report was 11.9 h (range 0.06–54.9). In five patients admitted directly to surgery, the mean time between POCUS and incision was 2.30 h (range 1.5–5), which was significantly shorter than the mean time to formal radiology report. Sixteen patients were discharged from the emergency department, of whom nine did not need follow-up. Our study is one of the very few to demonstrate a high concordance between surgeon-performed POCUS of patients without a priori radiologic diagnosis of gallstone disease and shows that the expedited diagnosis afforded by POCUS can be reliably leveraged to deliver earlier definitive care for patients with acute gallbladder pathology, as the general surgeon skilled in POCUS is uniquely positioned to integrate it into their bedside assessment.
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Affiliation(s)
- Bogdan-Daniel Dumbrava
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, D02 YN77 Dublin, Ireland
- Department of Surgery, Ponderas Academic Hospital, 014142 Bucharest, Romania
- Correspondence:
| | - Gary Alan Bass
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, D02 YN77 Dublin, Ireland
- Division of Traumatology, Emergency Surgery & Surgical Critical Care, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Amro Jumean
- Department of Surgery, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen 15503, Bahrain
| | - Nuha Birido
- Department of Surgery, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen 15503, Bahrain
| | - Martin Corbally
- Department of Surgery, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen 15503, Bahrain
| | - Jorge Pereira
- Department of Surgery, Tondela-Viseu Hospital Center, Av. Rei Dom Duarte, 3504-509 Viseu, Portugal
| | - Alan Biloslavo
- Department of Surgery, Cattinara University Hospital, Strada di Fiume 447, 34149 Trieste, Italy
| | - Mauro Zago
- Department of Surgery, Policlinico San Pietro, Via Carlo Forlanini 15, 24036 Ponte San Pietro, Italy
| | - Thomas Noel Walsh
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, D02 YN77 Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen 15503, Bahrain
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Irvine K, Alarcon M, Dyck H, Martin B, Carr T, Groot G. Virtual surgical consultation during the COVID-19 pandemic: a patient-oriented, cross-sectional study using telephone interviews. CMAJ Open 2022; 10:E1008-E1016. [PMID: 36446425 PMCID: PMC9718540 DOI: 10.9778/cmajo.20210159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Health care delivery shifted rapidly during the COVID-19 pandemic, whereby virtual consultations replaced many face-to-face interactions. We sought to gather patient perspectives on their experiences with virtual surgical consultation, the advantages and disadvantages of this delivery method and their overall satisfaction with virtual appointments. METHODS We conducted a patient-oriented, cross-sectional study. Adult patients (age > 18 yr) who had a virtual consultation with a participating general surgeon in Saskatoon, Saskatchewan, from April to May 2020 were eligible. We conducted telephone interviews using open- and close-ended questions. We used thematic analysis to determine themes from the qualitative data. As research team members, 2 patient partners were involved in identifying priorities, developing the research question, designing research methods, analyzing data and disseminating findings. We analyzed and presented quantitative data descriptively. RESULTS We interviewed 45 participants from 7 general surgery practices; the average age was 62 years. Most participants lived outside Saskatoon and had virtual follow-up appointments. The 3 themes related to advantages of virtual consultations were convenience, cost savings and decreased exposure to pathogens. The 4 themes related to their disadvantages were that they were not as personal, the surgeon was not able to perform a physical examination, and there were issues with scheduling and issues with technology. Most participants were satisfied with the care they received (n = 41) and would be willing to use virtual consultation in the future (n = 31). INTERPRETATION We found that virtual consultations are an effective and efficient way to deliver surgical care but are not appropriate for every situation and cannot completely replace face-to-face interactions. Our study identified the advantages and disadvantages of virtual surgical consultation to help better guide the delivery of virtual care in the future.
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Affiliation(s)
- Kyle Irvine
- Department of Surgery (Irvine), University of Saskatchewan; Clinical Research Support Unit (Alarcon), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Dyck, Martin); Department of Community Health and Epidemiology (Carr, Groot), University of Saskatchewan, Saskatoon, Sask.
| | - Marissa Alarcon
- Department of Surgery (Irvine), University of Saskatchewan; Clinical Research Support Unit (Alarcon), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Dyck, Martin); Department of Community Health and Epidemiology (Carr, Groot), University of Saskatchewan, Saskatoon, Sask
| | - Heather Dyck
- Department of Surgery (Irvine), University of Saskatchewan; Clinical Research Support Unit (Alarcon), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Dyck, Martin); Department of Community Health and Epidemiology (Carr, Groot), University of Saskatchewan, Saskatoon, Sask
| | - Barbara Martin
- Department of Surgery (Irvine), University of Saskatchewan; Clinical Research Support Unit (Alarcon), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Dyck, Martin); Department of Community Health and Epidemiology (Carr, Groot), University of Saskatchewan, Saskatoon, Sask
| | - Tracey Carr
- Department of Surgery (Irvine), University of Saskatchewan; Clinical Research Support Unit (Alarcon), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Dyck, Martin); Department of Community Health and Epidemiology (Carr, Groot), University of Saskatchewan, Saskatoon, Sask
| | - Gary Groot
- Department of Surgery (Irvine), University of Saskatchewan; Clinical Research Support Unit (Alarcon), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Dyck, Martin); Department of Community Health and Epidemiology (Carr, Groot), University of Saskatchewan, Saskatoon, Sask
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Khair A, Cromwell PM, Abdelatif A, Boland F, O'Reilly C, Maudarbaccus N, Aremu M, Arumugasamy M, Walsh TN. Text Messaging, Telephone, or In-Person Outpatient Visit to the Surgical Clinic: A Randomized Trial. J Surg Res 2022; 280:226-233. [PMID: 36007481 PMCID: PMC9394432 DOI: 10.1016/j.jss.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Routine outpatient follow-up visits for surgical patients are a source of strain on health-care resources and patients. With the COVID-19 pandemic adding a new urgency to finding the safest follow-up arrangement, text message follow-up might prove an acceptable alternative to a phone call or an in-person clinic visit. METHODS An open-label, three-arm, parallel randomized trial was conducted. The interventions were traditional in-person appointment, a telephone call, or a text message. The primary outcome was the number of postdischarge complications identified. The secondary outcomes were patient satisfaction with follow-up, future preference, default to follow-up, and preference to receiving medical information by text message. RESULTS Two hundred eight patients underwent randomization: 50 in the in-person group, 80 in the telephone group, and 78 in the text message group. There was no difference in the number of reported complications: 5 (10%) patients in the in-person group, 7 (9%) patients in the text group, and 11 (14%) patients in the telephone group (P = 0.613). The preferred method of follow-up was by telephone (106, 61.6%). The least preferred was the in-person follow-up (15, 8.7%, P = 0.002), which also had the highest default rate (44%). CONCLUSIONS There was no evidence that text messages and telephone calls are unsafe and ineffective methods of follow-up. Although most patients are happy to receive results by text message, the majority of patients would prefer a telephone follow-up and are less likely to default by this method. Health-care systems should develop telehealth initiatives when planning health-care services in the wake of the COVID-19 pandemic.
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Affiliation(s)
- Areeg Khair
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul M Cromwell
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Asila Abdelatif
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona Boland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colum O'Reilly
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nadiim Maudarbaccus
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Muyiwa Aremu
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mayilone Arumugasamy
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tom N Walsh
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
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Diehl TM, Barrett JR, Van Doorn R, Cherney Stafford LM, Hanlon BM, Weber SM, Voils CI, Abbott DE. Promoting patient engagement during care transitions after surgery using mobile technology: Lessons learned from the MobiMD pilot study. Surgery 2022; 172:219-225. [PMID: 35086727 PMCID: PMC11064743 DOI: 10.1016/j.surg.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poorly coordinated transitions of care in complex abdominal surgery patients contribute to frequent hospital readmissions and inflated healthcare spending. Mobile health (mHealth) transitional care technologies may reduce surgical readmissions yet remain understudied in high-risk surgical populations. METHODS We conducted a single-group, prepost study of a mHealth transitional care app in 50 complex surgical patients. Eligible patients were adults undergoing complex abdominal surgery in the divisions of Surgical Oncology and Colorectal Surgery. The main outcome was app engagement, calculated by notification response rate (number of participant-entered datapoints divided by the total number of app-requested datapoints) over the 30-day postoperative period. Secondary outcomes included changes in engagement over time and by individual app feature. RESULTS A total of 85% (50/59) of eligible patients enrolled. Most participants were male (58%, n = 29), and mean age was 50 years (range 24-80 years). Overall notification response rate was 28%. Among the 58% of participants (29/50) who engaged with the app at least once after discharge (app users), the average notification response rate was 45%. The mean notification response rate among app users decreased over time from 50% to 32% between weeks 1 and 4 after hospital discharge. Engagement with individual app features ranged from 48-81%, with highest engagement for symptom reports and lowest engagement for wound care instructions. CONCLUSION mHealth transitional care is feasible in complex surgical patients using only patients' existing smart devices. Randomized controlled trials are required to determine the impact on hospital readmissions, surgical outcomes, patient satisfaction, and overall resource utilization.
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Affiliation(s)
- Thomas M Diehl
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI. http://www.twitter.com/tomdiehlMD
| | - James R Barrett
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI
| | - Rachel Van Doorn
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI
| | - Linda M Cherney Stafford
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI
| | - Bret M Hanlon
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI; Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI
| | - Sharon M Weber
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI
| | - Corrine I Voils
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI. http://www.twitter.com/VoilsCorrine
| | - Daniel E Abbott
- Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI.
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Finnegan R, Flynn A, Flanagan O. Exploring parental experiences of virtual paediatric neurodevelopmental consultations. Ir J Med Sci 2022; 191:807-808. [PMID: 33755915 PMCID: PMC7985583 DOI: 10.1007/s11845-021-02583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/26/2021] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The coronavirus pandemic resulted in dramatic changes and challenges to healthcare practices. We endeavoured to establish the experiences of families of children attending a neurodevelopmental service after a transition to virtual consultations. METHODS Anonymous questionnaires were posted to parents of children registered in virtual clinics over a 10-week period. RESULTS Thirty parental questionnaires were completed. Parents reported a very high level of satisfaction (8.2/10) with previous face-to-face clinic appointments and virtual consultations (8.2/10). Individual aspects of virtual consultations received very positive ratings. Overall, 77% of parents highlighted a future preference for a combined service of both virtual and face-to-face consultations. CONCLUSIONS This study highlights the high level of parental satisfaction with the service, but especially satisfaction with the unplanned transition to virtual clinics. Virtual clinics cannot replace the holistic approach gained from face-to-face consultations; however, we identified their benefits of convenience and accessibility for our vulnerable population. In response, we have developed an integrated outpatient service involving both forms of consultation to potentiate satisfaction and adapt to meet the needs of our patients. The suggested proforma that has been developed offers a simple structure for undertaking a virtual consultation that can be adapted to different specialities, integrating the suggestions provided by our service users.
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Affiliation(s)
- Rebecca Finnegan
- Department of Paediatrics, Galway University Hospital, Galway, Ireland.
| | - Aoife Flynn
- Department of Paediatrics, Galway University Hospital, Galway, Ireland
| | - Orla Flanagan
- Department of Paediatrics, Galway University Hospital, Galway, Ireland
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12
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Chen J, Zheng B, Yin L, Zhou Q, Liu W, Li P, Zhao X, Chen X, Li Y, Ding H, Li G. Exploring agreement and feasibility between virtual home visits and in-person home visits for peritoneal dialysis patients-a paired study. Ren Fail 2022; 44:490-502. [PMID: 35285398 PMCID: PMC8928823 DOI: 10.1080/0886022x.2022.2049305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Virtual home visits may improve chronic disease management. However, whether they are suitable for peritoneal dialysis (PD) patients has not yet been fully investigated. This study aimed to compare the agreement and acceptance of virtual home visits and in-person home visits in PD patients. METHODS This was a paired, single center, noninferiority trial. Participants received a virtual home visit and an in-person home visit simultaneously. A home visit checklist was built for standardization visits. The content was divided into three parts: domestic habits (57 items), bag exchange procedures (56 items), and exit site care (53 items). Satisfaction questionnaires for both patients and nurses were designed to assess attitudes toward home visits and socioeconomic effects. RESULTS A total of 30 PD patients were enrolled in a single center. The information collected from virtual home visits and in-person home visits was found to be highly consistent. The perfect agreement was found in 52/57, 49/56, and 44/53 items (Cohen's kappa 0.81-1.00), substantial agreement in 4/57, 7/56, and 8/53 items (Cohen's kappa 0.61-0.80). Patients reported almost identical satisfaction for virtual home visits and in-person home visits (Z = 0.39, p = 0.70). PD nurses reported similar feasibility and patient cooperation for the two visit types (Z = 0.99, p = 0.33; Z = 1.65, p = 0.10, respectively). In addition, virtual home visits were found to be more cost-effective than in-person home visits. CONCLUSIONS Virtual home visits information collection was similar to in-person home visits in PD. There were no differences in participant satisfaction and feasibility between the two visit types.
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Affiliation(s)
- Jin Chen
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Zheng
- Department of Sanitary Technology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lijuan Yin
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qin Zhou
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenshu Liu
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Pengli Li
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiuxiu Zhao
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiuling Chen
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Li
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hanlu Ding
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guisen Li
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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13
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Sreedharan S, Nemeth LS, Hirsch J, Evans HL. Patient and Provider Preferences for Monitoring Surgical Wounds Using an mHealth App: A Formative Qualitative Analysis. Surg Infect (Larchmt) 2022; 23:168-173. [PMID: 35021883 PMCID: PMC8892972 DOI: 10.1089/sur.2021.240] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Surgical site infections complicate approximately 10% of all inpatient operations and account for nearly 20% of surgical re-admissions. Post-operative hospitalizations have become shorter over time, yet limited resources exist for patients to use at their home to communicate surgical wound problems with their medical providers. This study evaluated the attitudes of patients and providers towards using a remote wound monitoring application. Methods: This formative descriptive qualitative study reports the result of analysis of the interview content of five patients and five providers from a colorectal surgery clinic at the Medical University of South Carolina in Charleston, South Carolina. Semi-structured, face-to-face interviews were conducted in the clinic setting, were recorded, and professionally transcribed. Two of the authors independently reviewed and coded the transcribed interviews to identify themes across all 10 interviews. After independent coding, authors reviewed findings to reconcile and streamline the primary themes representing attitudes of patients and providers toward remote wound monitoring. Results: Five primary codes were found across our interviews: current barriers, infection types, workflow, interest in surgical site infection (SSI) monitoring, application considerations, and requested application features. We subcoded "symptom clarification" and "positive anticipation" under "interest in SSI monitoring," as well as "anticipated issues" and "application features" under "application considerations." From these codes, we synthesized findings into three overarching themes: smartphone app for remote wound monitoring has potential to improve patient-provider communication, specific wound evaluation processes are acceptable to patients and providers, and new collaboration with telehealth service is a welcome addition for interdisciplinary team management. Conclusions: A prospective approach to the development of a remote wound monitoring application enables a user-centric development process. Our analysis shows a readiness from both patients and providers to implement remote wound monitoring for identifying potential SSIs and coordinating surgical wound care within the community.
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Affiliation(s)
- Shilpa Sreedharan
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Lynne S. Nemeth
- College of Nursing, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jason Hirsch
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Heather L. Evans
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.,Address correspondence to: Dr. Heather L. Evans, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
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14
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Diehl TM, Barrett JR, Abbott DE, Cherney Stafford LM, Hanlon BM, Yang Q, Van Doorn R, Weber SM, Voils CI. Protocol for the MobiMD trial: A randomized controlled trial to evaluate the effect of a self-monitoring mobile app on hospital readmissions for complex surgical patients. Contemp Clin Trials 2022; 113:106658. [PMID: 34954099 PMCID: PMC8844087 DOI: 10.1016/j.cct.2021.106658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hospital readmissions are estimated to cost $17.4 billion per year in the Medicare population alone, with readmission rates as high as 30% for patients undergoing complex abdominal surgery. Improved transitional care and self-monitoring may reduce preventable readmissions for such high-risk populations. In this study, we will conduct a single-institution randomized controlled trial (RCT) to assess the effect of a novel transitional care mobile app, MobiMD, on hospital readmission in complex abdominal surgery patients. METHODS Three hundred patients will be randomized 1:1 to standard of care (SOC) versus SOC plus MobiMD app in a parallel, single-blinded, two-arm RCT. Eligible patients are those who undergo complex abdominal surgery in the division of Surgical Oncology, Colorectal Surgery or Transplant Surgery. The MobiMD app provides push notification reminders directly to the patient's smart device, prompting them to enter clinical data and patient-reported outcomes. Clinical data collected via the MobiMD app include vital signs, red flag symptoms, daily wound and surgical drain images, ostomy output, drain output, medication compliance, and wound care compliance. These data are reviewed daily by a physician. The primary outcome is the proportion of participants readmitted to the hospital within 30 days of surgery. Secondary outcomes are 90-day hospital readmission, emergency department and urgent care visits, complication severity, and total readmission cost. DISCUSSION If effective, mobile health apps such as MobiMD could be routinely integrated into surgical transitional care programs to minimize unnecessary hospital readmissions, emergency department visits and healthcare resource utilization. Clinical trials identifier: NCT04540315.
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Affiliation(s)
- Thomas M Diehl
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - James R Barrett
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Daniel E Abbott
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Linda M Cherney Stafford
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Bret M Hanlon
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin, WARF Room 201, 610 Walnut Street, Madison, WI 53726, USA.
| | - Qiuyu Yang
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin, WARF Room 201, 610 Walnut Street, Madison, WI 53726, USA.
| | - Rachel Van Doorn
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Sharon M Weber
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Corrine I Voils
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA; William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace (151), Madison, WI 53705, USA.
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15
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Li C(Z, Borycki EM, Kushniruk AW. Connecting the World of Healthcare Virtually: A Scoping Review on Virtual Care Delivery. Healthcare (Basel) 2021; 9:1325. [PMID: 34683005 PMCID: PMC8544348 DOI: 10.3390/healthcare9101325] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 11/23/2022] Open
Abstract
Virtual care extends beyond the walls of healthcare organizations to provide care at a distance. Although virtual care cannot be regarded as a solution for all health-related inquiries, it provides another care delivery channel for specific patient populations with appointments that do not require in-person physical examinations or procedures. A scoping review was conducted to define the meaning of virtual care, understand how virtual care has influenced the healthcare industry and is being expanded to complement the existing healthcare system, and describe the outcomes of using virtual care for patients and providers. Findings from the scoping review suggest that virtual care encompasses the provision of care using advanced video conferencing technology to support remote care that takes place between patients and providers and the use of virtual reality technology to simulate care environments. Some of virtual care's use in healthcare includes application to pain and anxiety management, virtual consultations and follow-up visits, rehabilitation and therapy services, outpatient clinics, and emergency services. Lastly, from a provider and patient perspective, while both saw benefits of virtual care and scored the service relatively high on satisfaction after using virtual care, the greatest barrier to using virtual care may be technological challenges.
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Affiliation(s)
- Cindy (Zhirui) Li
- School of Health Information Science, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Elizabeth M. Borycki
- School of Health Information Science, University of Victoria, Victoria, BC V8P 5C2, Canada
- Michael Smith Foundation for Health Research, Vancouver, BC V6H 3X8, Canada
| | - Andre W. Kushniruk
- School of Health Information Science, University of Victoria, Victoria, BC V8P 5C2, Canada
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16
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Oates EV, Lim GHC, Nevins EJ, Kanakala V. Are Surgical Patients Satisfied With Remote Consultations? A Comparison of Remote Versus Conventional Outpatient Clinic Follow-Up for Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Patient Exp 2021; 8:23743735211035916. [PMID: 34377778 PMCID: PMC8326624 DOI: 10.1177/23743735211035916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Access to remote appointments (RA) by telephone or video is increasing as technology advances and becomes more available to patients. This meta-analysis of randomized controlled trials (RCTs) aims to discover whether surgical patients are satisfied with RAs when compared with conventional outpatient clinics (OPC). A literature search of RCTs of surgical patient satisfaction of RAs versus OPC appointments was performed. The PubMed, EMBASE, OVID, Cochrane Library, and Google Scholar databases were searched to include articles from January 2000 to 2020. A random-effects meta-analysis model was used to compare outcomes. All 7 RCTs showed that patients were as satisfied with RAs as OPC appointments (RR = 1.00, [0.98-1.02]; P = .73). Furthermore, both patient cohorts would prefer RAs for future follow-up (RR = 2.29, [1.96-2.97]; P < .00001). One RCT found the cost to institutions was less in the RA group ($19.05 vs $52.76) and another found the patients would save $9.96 on transportation costs. The majority of RCTs suggested cost to patients and or institutions would be less for RA. In conclusion, surgical patients are satisfied with RAs and in fact would prefer them.
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Affiliation(s)
- Emily V Oates
- James Cook University Hospital, England, United Kingdom
| | - Grace H C Lim
- James Cook University Hospital, England, United Kingdom
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17
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Geoghegan L, Scarborough A, Wormald JCR, Harrison CJ, Collins D, Gardiner M, Bruce J, Rodrigues JN. Automated conversational agents for post-intervention follow-up: a systematic review. BJS Open 2021; 5:zrab070. [PMID: 34323916 PMCID: PMC8320342 DOI: 10.1093/bjsopen/zrab070] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/17/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Advances in natural language processing and other machine learning techniques have led to the development of automated agents (chatbots) that mimic human conversation. These systems have mainly been used in commercial settings, and within medicine, for symptom checking and psychotherapy. The aim of this systematic review was to determine the acceptability and implementation success of chatbots in the follow-up of patients who have undergone a physical healthcare intervention. METHODS A systematic review of MEDLINE, MEDLINE In-process, EMBASE, PsychINFO, CINAHL, CENTRAL and the grey literature using a PRISMA-compliant methodology up to September 2020 was conducted. Abstract screening and data extraction were performed in duplicate. Risk of bias and quality assessments were performed for each study. RESULTS The search identified 904 studies of which 10 met full inclusion criteria: three randomised control trials, one non-randomised clinical trial and six cohort studies. Chatbots were used for monitoring after the management of cancer, hypertension and asthma, orthopaedic intervention, ureteroscopy and intervention for varicose veins. All chatbots were deployed on mobile devices. A number of metrics were identified and ranged from a 31 per cent chatbot engagement rate to a 97 per cent response rate for system-generated questions. No study examined patient safety. CONCLUSION A range of chatbot builds and uses was identified. Further investigation of acceptability, efficacy and mechanistic evaluation in outpatient care pathways may lend support to implementation in routine clinical care.
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Affiliation(s)
- L Geoghegan
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Scarborough
- Department of Cardiothoracic Surgery, King’s College Hospital, London, UK
| | - J C R Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - C J Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - D Collins
- Department of Plastic, Reconstructive and Burns Surgery, Chelsea and Westminster Hospital, London, UK
| | - M Gardiner
- Department of Plastic and Reconstructive Surgery, Frimley Park Hospital, Guildford, UK
| | - J Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - J N Rodrigues
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Plastic and Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, UK
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18
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Mair J, Woolley M, Grainger R. Abrupt change to telephone follow-up clinics in a regional rheumatology service during COVID-19: analysis of treatment decisions. Intern Med J 2021; 51:960-964. [PMID: 34155761 PMCID: PMC8447013 DOI: 10.1111/imj.15336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/24/2021] [Accepted: 04/13/2021] [Indexed: 01/21/2023]
Abstract
During the 2020 COVID‐19 lockdown our rheumatology service provided follow up by phone. We reviewed clinic documents to compare patients serviced, and patient assessment and treatment outcomes. More patients received care during the lockdown but patient rheumatic disease was deemed active less frequently, more patients had no change to disease‐modifying anti‐rheumatic drugs and patients were less likely to have an intervention arranged. This suggests careful patient selection and appropriate infrastructure should be part of future rheumatology telemedicine.
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Affiliation(s)
- Jonathan Mair
- Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Michelle Woolley
- Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Rebecca Grainger
- Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand.,Department of Medicine, University of Otago Wellington, Wellington, New Zealand
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19
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Byravan S, Sunmboye K. The Impact of the Coronavirus (COVID-19) Pandemic on Outpatient Services-An Analysis of Patient Feedback of Virtual Outpatient Clinics in a Tertiary Teaching Center With a Focus on Musculoskeletal and Rheumatology Services. J Patient Exp 2021; 8:23743735211008284. [PMID: 34179426 PMCID: PMC8205348 DOI: 10.1177/23743735211008284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The pandemic has resulted in many changes to health services, one of these is the shift from face-to-face consultations to virtual ones across all specialities. As the pandemic continues with no end in sight it seems that virtual consultations will continue for the foreseeable future. In this article, we analyze the patient feedback so far to virtual consultations in a large tertiary center and use this opportunity to reflect on this new service. We have a particular interest in musculoskeletal services as this is largely an outpatient-based speciality and the pandemic has consequently resulted in significant changes in practice. We also consider whether virtual clinics is a sustainable service post-COVID-19 and the benefits and disadvantages of this.
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Affiliation(s)
- Swetha Byravan
- Rheumatology, University Hospitals of Leicester, Infirmary Square, Leicester, United Kingdom
| | - Kehinde Sunmboye
- Rheumatology, University Hospitals of Leicester, Infirmary Square, Leicester, United Kingdom
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20
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Alexander KE, Ogle T, Hoberg H, Linley L, Bradford N. Patient preferences for using technology in communication about symptoms post hospital discharge. BMC Health Serv Res 2021; 21:141. [PMID: 33588829 PMCID: PMC7882859 DOI: 10.1186/s12913-021-06119-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/25/2021] [Indexed: 12/21/2022] Open
Abstract
Background Technology is increasingly transforming the way we interact with others and undertake activities in our daily lives. The healthcare setting has, however, not yet realised the potential of technology solutions to facilitate communication between patients and healthcare providers. While the procedural and policy requirements of healthcare systems will ultimately drive such solutions, understanding the preferences and attitudes of patients is essential to ensure that technology implemented in the healthcare setting facilitates communication in safe, acceptable, and appropriate ways. Therefore, the purpose of this study was to examine patient preferences for using technology to communicate with health service providers about symptoms experienced following discharge from the hospital. Methods Primary data were collected from patients admitted to a large metropolitan hospital in Australia during three consecutive months in 2018. Participants were asked about their daily use of technology including use of computers, email, phone, text messaging, mobile applications, social media, online discussion forums, and videoconference. They were then asked about their use of technologies in managing their health, and preferences for use when communicating about symptoms with health service providers following discharge from hospital. Results Five hundred and twenty-five patients with a wide range of differing clinical conditions and demographics participated. Patients indicated they used a range of technologies in their everyday lives and to manage their health. Almost 60% of patients would prefer to return to hospital if they were experiencing symptoms of concern. However, if patients experienced symptoms that were not of concern, over 60% would prefer to communicate with the hospital via telephone or using technology. Admitting condition, income, and age were significantly associated with preferences for communication about symptoms following hospital discharge. Conclusions Patients have varied preferences for communicating with their health service providers post-hospital discharge. Findings suggest that some, but not all patients, would prefer to use technology to traditional methods of communicating with the healthcare team. Health services should offer patients multiple options for communicating about their recovery to ensure individual needs are appropriately met. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06119-7.
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Affiliation(s)
- Kim E Alexander
- Queensland University of Technology (QUT), Centre for Healthcare Transformation, Cancer & Palliative Care Outcomes Centre, Brisbane, Australia. .,St Vincent's Private Hospital Northside, Brisbane, Australia.
| | - Theodora Ogle
- Queensland University of Technology (QUT), Centre for Healthcare Transformation, Cancer & Palliative Care Outcomes Centre, Brisbane, Australia
| | - Hana Hoberg
- Queensland University of Technology (QUT), Centre for Healthcare Transformation, Cancer & Palliative Care Outcomes Centre, Brisbane, Australia
| | - Libbie Linley
- St Vincent's Private Hospital Northside, Brisbane, Australia
| | - Natalie Bradford
- Queensland University of Technology (QUT), Centre for Healthcare Transformation, Cancer & Palliative Care Outcomes Centre, Brisbane, Australia
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21
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Dalby M, Hill A, Nabhani-Gebara S. Cancer patient experience of telephone clinics implemented in light of COVID-19. J Oncol Pharm Pract 2021; 27:644-649. [PMID: 33504269 PMCID: PMC7862913 DOI: 10.1177/1078155221990101] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction Due to the pandemic of COVID-19 a number of National Health Service (NHS) Trusts in the UK adopted telephone consultations for patients who were shielding. As the pandemic continues to affect these services an evaluation was conducted to determine whether telephone consultations implemented during the pandemic should be maintained long term. The objective was to evaluate this new service and to understand patient experience. Methods This study was conducted via a telephone survey. Staff working in the Macmillan centres across the Trust called patients to survey them about their experience of telephone consultations. Data were collected 23/06/20 – 17/07/20. A mix of eight open and closed questions were asked. Data were collected on an Excel spreadsheet and patient identifiable information was anonymised. Results 55 patients accepted to participate in this study. Out of 55, 39 patients rated the phone consultation they had as either 4 or 5 out of 5. When asked if they would like to continue with phone clinics 33 said they would. The majority of consultations were conducted by doctors (43/55). Patients commented they had received great support from their healthcare professionals and they felt that phone consultations were safer in the current climate. Three of the patients felt the calls were rushed and others found it difficult to discuss pain management, sides effects and post-surgery issues. Conclusions This evaluation provides a brief snapshot of the experience cancer patients are having with phone clinics. A re-evaluation will take place once video consultations are implemented.
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22
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Saleh M, Caron J, Hernandez S, Boyd L. Determinants of Clinic Absenteeism in Gynecologic Oncology Clinic at a Safety Net Hospital. J Community Health 2021; 46:399-404. [PMID: 33389474 DOI: 10.1007/s10900-020-00942-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
There have long been noted significant health disparities related to cancer in populations comprised of low-income and minority individuals, including those with gynecologic cancers. Compliance with appointments related to cancer care is critical to ensuring timely diagnosis, treatment, and detection of disease progression. At a public safety net hospital in New York City, the rate of clinic absenteeism in gynecologic oncology clinic was noted to be nearly 20%. This prospective, survey-based study catalogued reasons for clinic absenteeism and noted that the most common reason an appointment was missed was the patient being unaware it existed. Next most common reasons were medical conflicts and family obligations. Patients at this clinic would benefit from a clinic navigator to assist with scheduling appointments, remind patients of upcoming appointments, and resolve conflicting medical appointments.
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Affiliation(s)
- Mona Saleh
- Department of Obstetrics & Gynecology, New York University Langone Health, New York, NY, USA.
| | - Jayne Caron
- Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sasha Hernandez
- Department of Obstetrics & Gynecology, New York University Langone Health, New York, NY, USA
| | - Leslie Boyd
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, New York University Langone Health, New York, NY, USA
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23
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D'Cruz RJ, MacDonald LQ, Zisa N, Zomorrodi A, Murren-Boezem J, Atanda A, Hirschfeld F, Berman L. Institution-initiated text messaging can reduce unplanned emergency department visits after appendectomy. J Pediatr Surg 2021; 56:37-42. [PMID: 33139024 DOI: 10.1016/j.jpedsurg.2020.09.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to reduce unplanned Emergency Department (ED) visits for minor complaints in children after appendectomy through proactive institution-driven communication and utilization of telehealth resources. METHODS We developed a text messaging system to initiate communication with parents of postappendectomy patients and connect them with a telehealth visit or a phone call with a surgical provider as needed. Using descriptive statistics, chi square, and statistical process control analytics, we compared rates of postoperative ED visits for the 8 months pre- and post-implementation of the messaging system and summarized the feedback we received from patients. RESULTS A total of 791 laparoscopic appendectomies were performed in two institutions (preintervention = 382, post-intervention = 409). The postoperative ED visit rate decreased from 5.8% preimplementation to 2.4% post-implementation (p = 0.02). Over one-fifth of families messaged (21.6%) had questions in the postoperative period. The majority expressed interest in a video visit (52.5%), while some preferred to speak with the surgeon's office (25%). Over 90% of respondents found the system helpful, and 4.9% opted out. CONCLUSION Implementation of a hospital-initiated text messaging system has the potential to reduce ED visits in the immediate postoperative period after appendectomy. This system can be scaled to include different surgeries across multiple disciplines. LEVEL OF EVIDENCE III. TYPE OF STUDY Clinical Retrospective Pre/Post Intervention Study.
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Affiliation(s)
- Roshan J D'Cruz
- Dept. of Pediatric General Surgery, Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, USA 19803.
| | - Lisa-Qiao MacDonald
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 111 S 11th St Philadelphia, PA, USA 19107
| | - Natalina Zisa
- Nemours Children's Hospital, 13535 Nemours Pkwy, Orlando, FL 32827
| | - Arezoo Zomorrodi
- Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, USA 19803
| | | | - Alfred Atanda
- Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, USA 19803
| | - Fiona Hirschfeld
- Nemours Center for Health Delivery Innovation, Wilmington, Delaware, USA 19803
| | - Loren Berman
- Dept. of Pediatric General Surgery, Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, USA 19803; Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 111 S 11th St Philadelphia, PA, USA 19107
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Byrne E, Watkinson S. Patient and clinician satisfaction with video consultations during the COVID-19 pandemic: an opportunity for a new way of working. J Orthod 2020; 48:64-73. [PMID: 33251951 DOI: 10.1177/1465312520973677] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess satisfaction of patients and clinicians with virtual appointments using Attend Anywhere for their orthodontic consultation and to identify any areas where the technology could be further utilised. DESIGN Service evaluation involving descriptive cross-sectional questionnaire. SETTING Orthodontic Departments at Royal Blackburn Teaching Hospital and Burnley General Teaching Hospital. PARTICIPANTS Patients and clinicians involved in video consultations. METHODS Patient- and clinician-specific questionnaires were designed and those involved in virtual clinics were invited to complete these at the end of their consultation. The questionnaires focused on setting up and connecting to the virtual clinic, assessing if the correct types of patients were involved in the clinics and satisfaction with these types of remote consultations. RESULTS A total of 121 questionnaires (59 patient and 62 clinician) were completed. Of the patients, 93% found the instructions provided to access the consultation easy to follow and 70% of clinicians did not report any connection issues. In 90% of cases, a virtual appointment was seen to be appropriate by the clinician. Respondents showed a high level of satisfaction with 76% of patients saying a remote consultation was more convenient than face-to-face, and 66% reporting they would, if appropriate, like more appointments like this in the future. CONCLUSION The overall satisfaction among patients with virtual clinics introduced during the COVID-19 pandemic was generally high. The majority of patients would, where appropriate, prefer more virtual appointments in the future in comparison to face-to-face appointments and it was found to be more convenient for the patient.
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Affiliation(s)
- Emer Byrne
- Department of Orthodontics, University Dental Hospital of Manchester, Manchester and East Lancashire Hospitals NHS Trust, UK
| | - Simon Watkinson
- Department of Orthodontics, University Dental Hospital of Manchester, Manchester and East Lancashire Hospitals NHS Trust, UK
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Darr A, Senior A, Argyriou K, Limbrick J, Nie H, Kantczak A, Stephenson K, Parmar A, Grainger J. The impact of the coronavirus (COVID-19) pandemic on elective paediatric otolaryngology outpatient services - An analysis of virtual outpatient clinics in a tertiary referral centre using the modified paediatric otolaryngology telemedicine satisfaction survey (POTSS). Int J Pediatr Otorhinolaryngol 2020; 138:110383. [PMID: 33152974 PMCID: PMC7515596 DOI: 10.1016/j.ijporl.2020.110383] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Virtual outpatient clinics (VOPC) have been integrated into both paediatric and based adult outpatient services due to a multitude of factors, including increased demand for services, technological advances and rising morbidity secondary to ageing populations. The novel coronavirus disease (COVID-19) has accentuated pressures on the National Health Service (NHS) infrastructure, particularly elective services, whilst radically altering patterns of practice. AIM To evaluate the impact of the COVID-19 pandemic on paediatric otolaryngology outpatient services whilst collating patient feedback to elicit long-term sustainability post COVID-19. METHOD A retrospective analysis of VOPCs was undertaken at a tertiary paediatric referral centre over a 3-month capture period during the COVID-19 pandemic. Demographic, generic clinic (presenting complaint, new vs. follow-up, consultation type), as well as outcome data (medical or surgical intervention, discharge vs. ongoing review, onward referral, investigations, and conversion to face-to-face) was collated. Additionally a modified 15-point patient satisfaction survey was created. The Paediatric Otolaryngology Telemedicine Satisfaction survey (POTSS), was an adaptation of 4 validated patient satisfaction tools including the General Medical Council (GMC) patient questionnaire, the telehealth satisfaction scale (TESS), the telehealth usability questionnaire (TUQ), and the telemedicine satisfaction and usefulness questionnaire (TSUQ). RESULTS Of 514 patients reviewed virtually over a 3-month period, 225 (45%) were randomly selected to participate, of which 200 met our inclusion criteria. The most common mode of consultation was telephony (92.5%, n = 185). Non-attendance rates were reduced when compared to face-to-face clinics during an equivalent period prior to the COVID-19 pandemic. A significant proportion of patients (29% compared to 26% pre-VOPC) were discharged to primary care. Nine percent were listed for surgery compared to 19% pre-VOPC. A subsequent face-to-face appointment was required in 10% of participants. Overall, the satisfaction when assessing the doctor-patient relationship, privacy & trust, as well as consultation domains was high, with the overwhelming majority of parents' content with the future integration and participation in VOPCs. CONCLUSION An evolving worldwide pandemic has accelerated the need for healthcare services to reform in order to maintain a steady flow of patients within an elective outpatient setting without compromising patient care. Solutions must be sustainable long-term to account for future disruptions, whilst accounting for evolving patient demographics. Our novel survey has demonstrated the vast potential that the integration of VOPCs can offer paediatric otolaryngology services within a carefully selected cohort of patients.
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Affiliation(s)
- Adnan Darr
- Birmingham Women's and Children's NHS Foundation Trust, United Kingdom.
| | - Andrew Senior
- Birmingham Women's and Children's NHS Foundation Trust, United Kingdom.
| | - Kalliopi Argyriou
- Birmingham Women's and Children's NHS Foundation Trust, United Kingdom.
| | - Jack Limbrick
- Birmingham Women's and Children's NHS Foundation Trust, United Kingdom.
| | - Huimin Nie
- Birmingham Women's and Children's NHS Foundation Trust, United Kingdom
| | - Ada Kantczak
- Birmingham Women's and Children's NHS Foundation Trust, United Kingdom.
| | - Kate Stephenson
- Birmingham Women's and Children's NHS Foundation Trust, United Kingdom.
| | - Amit Parmar
- Birmingham Women's and Children's NHS Foundation Trust, United Kingdom.
| | - Joe Grainger
- Birmingham Women's and Children's NHS Foundation Trust, United Kingdom.
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O' Reilly M, Merghani K, Bayer T. Virtual Assessment and Management in Foot and Ankle Surgery During the COVID-19 Pandemic: An Irish Experience. J Foot Ankle Surg 2020; 59:876. [PMID: 32773319 PMCID: PMC7307989 DOI: 10.1053/j.jfas.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Marc O' Reilly
- Trainee, Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Tullamore, Co. Offaly, Ireland.
| | - Khalid Merghani
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Tullamore, Co. Offaly, Ireland
| | - Thomas Bayer
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Tullamore, Co. Offaly, Ireland
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Thelwall C. A Service Evaluation after 4 year's use of the Virtual Fracture Clinic model by a District General Hospital in the South West of England. Int J Orthop Trauma Nurs 2020; 41:100798. [PMID: 32883628 DOI: 10.1016/j.ijotn.2020.100798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/17/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION A Virtual fracture clinic (VFC) was set up in 2015. An initial patient satisfaction survey demonstrated satisfaction with the service. The purpose of this service evaluation was to re-evaluate the VFC by reporting on patient satisfaction. A small audit was undertaken alongside to examine the time taken from ED presentation to VFC review against the British Orthopaedic Association Society for Trauma (BOAST) guidelines of 72 h. PATIENTS AND METHODS All patients discharged from VFC in August 2019 were eligible to take part in the patient satisfaction survey. The Electronic Patients Records System (EPRS) was used to generate data regarding time of review and patient return for follow up appointments. RESULTS The results demonstrated that 88% of patients would recommend the service to friends. More than 80% of patients were satisfied with various elements of the service and 80% of patients are seen within the target time of 72 h. CONCLUSIONS Patients continue to be satisfied with the VFC. There seems to be a greater acceptance of not being reviewed by a doctor. In general, patients were seen within 72 h of ED presentation but more work is needed to streamline the process of tertiary referrals.
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Affiliation(s)
- Claire Thelwall
- Trauma and Orthopaedic Department, Great Western Hospitals NHS Trust, Marlborought Road, Swindon SN3 6BB, United Kingdom.
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28
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Brosnan C, Hannan E, Duggan W, Harding T, Maguire D, Stafford AT. Diagnostic Inaccuracies of Barrett's Oesophagus on Gastroscopy: Are We Performing Unnecessary Surveillance? Cureus 2020; 12:e9850. [PMID: 32953357 PMCID: PMC7497227 DOI: 10.7759/cureus.9850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background It is common for patients to enter Barrett's oesophagus (BO) surveillance based on endoscopic appearances before the diagnosis is histologically confirmed. We set out to review this practice by establishing the accuracy of endoscopic diagnoses of BO. Methods All gastroscopy reports in which a diagnosis of BO was recorded were reviewed over one year. These were compared to the histopathological reports to assess diagnostic accuracy. Results BO was diagnosed in 84 procedures. This diagnosis was incorrect according to histology in 42.9% (n=36) of cases. Diagnostic accuracy was higher with gastroenterologists (38.8% incorrect, n=21) compared to surgeons (50% incorrect, n=15). Diagnostic accuracy was higher with consultants (34.9% incorrect, n=22) compared to registrars (66.7% incorrect, n=14). The dose of sedation used had no impact on accuracy. Unnecessary surveillance was booked in 36.1% (n=13) of cases. Conclusion It is insufficient to rely on endoscopic appearances alone to diagnose BO, irrespective of speciality or experience. The diagnosis should only be made after reviewing the histopathology report. This can eliminate unnecessary repeat endoscopy procedures, sparing patients from unjustifiable risk and helping to cut down on long waiting lists in endoscopy departments. The implementation of the Prague classification and Seattle protocol can improve diagnostic accuracy.
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Affiliation(s)
- Conor Brosnan
- General Surgery, St. Michael's Hospital, Dublin, IRL
| | - Enda Hannan
- Colorectal Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Tim Harding
- General Surgery, St. Michael's Hospital, Dublin, IRL
| | - Donal Maguire
- General Surgery, St. Michael's Hospital, Dublin, IRL
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Wong FL, Antoniou G, Williams N, Cundy PJ. Disruption of paediatric orthopaedic hospital services due to the COVID-19 pandemic in a region with minimal COVID-19 illness. J Child Orthop 2020; 14:245-251. [PMID: 32874355 PMCID: PMC7453176 DOI: 10.1302/1863-2548.14.200140] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study was designed to evaluate the impact of the COVID-19 pandemic on paediatric orthopaedic services in a paediatric tertiary hospital in South Australia. METHODS A retrospective audit was conducted of orthopaedic activity at a major paediatric tertiary hospital with a Level 1 paediatric trauma centre, where no patients were admitted with COVID-19 illness. Orthopaedic Emergency Department (ED) presentations, outpatient clinics and hospital admissions for the period between 16 March 2020 to 26 April 2020 were studied and compared with the same period in 2019 (18 March 2019 to 28 April 2019). Chi-square tests were performed with p < 0.05 indicating statistical significance. RESULTS In total, 621 patients presented to the ED with orthopaedic complaints during the pandemic (versus 997 in 2019). However, there was minimal change in the number of ED presentations requiring admission (110 in 2020 versus 116 in 2019). Among patients discharged directly from ED, 27.3% received hospital outpatient referral (versus 39.1% in 2019), with the remaining patients referred to community health services or discharged directly.There was a 509.8% increase in telehealth (video and phone) outpatient consultations compared to 2019 and a 60.6% decline in face-to-face appointments. There was a total of 144 orthopaedic admissions (elective and emergency) compared to 184 in 2019. Admissions for children under seven remained unchanged (32.5% reduction in children aged seven and above). CONCLUSION Despite an overall decline in all paediatric orthopaedic hospital activity, the number of emergency admissions for musculoskeletal conditions did not change. Elective surgery numbers for children aged under seven were also unchanged. Appropriate planning and hospital resources allocation are necessary to meet this service requirement in future pandemics.Level of evidence IV.
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Affiliation(s)
- Fui Lin Wong
- University of Glasgow, Glasgow, UK,Department of Orthopaedic Surgery, Women’s and Children’s Hospital Adelaide, North Adelaide, Australia
| | - Georgia Antoniou
- Department of Orthopaedic Surgery, Women’s and Children’s Hospital Adelaide, North Adelaide, Australia
| | - Nicole Williams
- Department of Orthopaedic Surgery, Women’s and Children’s Hospital Adelaide, North Adelaide, Australia,Centre of Orthopaedic and Trauma Research, University of Adelaide, Adelaide, Australia
| | - Peter J. Cundy
- Department of Orthopaedic Surgery, Women’s and Children’s Hospital Adelaide, North Adelaide, Australia,Centre of Orthopaedic and Trauma Research, University of Adelaide, Adelaide, Australia,Correspondence should be sent to Peter J. Cundy, Department of Orthopaedic Surgery, Women’s and Children’s Hospital Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia. E-mail: ;
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Koziatek CA, Rubin A, Lakdawala V, Lee DC, Swartz J, Auld E, Smith SW, Reddy H, Jamin C, Testa P, Femia R, Caspers C. Assessing the Impact of a Rapidly Scaled Virtual Urgent Care in New York City During the COVID-19 Pandemic. J Emerg Med 2020; 59:610-618. [PMID: 32737005 PMCID: PMC7290166 DOI: 10.1016/j.jemermed.2020.06.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The coronavirus disease (COVID)-19 pandemic quickly challenged New York City health care systems. Telemedicine has been suggested to manage acute complaints and divert patients from in-person care. OBJECTIVES The objective of this study was to describe and assess the impact of a rapidly scaled virtual urgent care platform during the COVID-19 pandemic. METHODS This was a retrospective cohort study of all patients who presented to a virtual urgent care platform over 1 month during the COVID-19 pandemic surge. We described scaling our telemedicine urgent care capacity, described patient clinical characteristics, assessed for emergency department (ED) referrals, and analyzed postvisit surveys. RESULTS During the study period, a total of 17,730 patients were seen via virtual urgent care; 454 (2.56%) were referred to an ED. The most frequent diagnoses were COVID-19 related or upper respiratory symptoms. Geospatial analysis indicated a wide catchment area. There were 251 providers onboarded to the platform; at peak, 62 providers supplied 364 h of coverage in 1 day. The average patient satisfaction score was 4.4/5. There were 2668 patients (15.05%) who responded to the postvisit survey; 1236 (49.35%) would have sought care in an ED (11.86%) or in-person urgent care (37.49%). CONCLUSIONS A virtual urgent care platform was scaled to manage a volume of more than 800 patients a day across a large catchment area during the pandemic surge. About half of the patients would otherwise have presented to an ED or urgent care in person. Virtual urgent care is an option for appropriate patients while minimizing in-person visits during the COVID-19 pandemic.
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Affiliation(s)
- Christian A Koziatek
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Ada Rubin
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Viraj Lakdawala
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York; Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Jordan Swartz
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Elizabeth Auld
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Silas W Smith
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York; Institute for Innovations in Medical Education, New York University School of Medicine, New York, New York
| | - Harita Reddy
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Catherine Jamin
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Paul Testa
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Robert Femia
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
| | - Christopher Caspers
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; Department of Emergency Medicine, Bellevue Hospital Center, New York, New York
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O' Reilly MF, Merghani K, Sheehan E. Virtualised care and COVID-19. Ir J Med Sci 2020; 190:39-40. [PMID: 32468414 PMCID: PMC8848340 DOI: 10.1007/s11845-020-02269-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/22/2020] [Indexed: 11/28/2022]
Abstract
Following the declaration by the World Health Organization (WHO) of the Covid-19 pandemic on March 11, 2020, health organisations and staff have had to adapt and restructure services in order to respond to this global health emergency. Numerous containment strategies have been, and continue to be, introduced in this rapidly evolving and fluid situation with a significant shift towards virtual or remote patient assessment. The concept of virtual patient evaluation has previously been adopted across a range of medical and surgical specialities yielding safe and efficient pathways associated with good Patient Reported Outcome Measures (PROMs) and patient satisfaction rates. Whilst the idea of virtual patient review may be perceived as counterintuitive to the basic foundations and principles of face-to-face clinical practice, the current global pandemic, now more than ever, highlights the importance, need and benefits of this care model.
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Affiliation(s)
- M F O' Reilly
- Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Arden Road, Tullamore, Co. Offaly, R35 NY51, Ireland.
| | - K Merghani
- Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Arden Road, Tullamore, Co. Offaly, R35 NY51, Ireland.,Graduate Entry Medical School, University of Limerick, Castletroy, Limerick, V94 T9PX, Ireland
| | - E Sheehan
- Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Arden Road, Tullamore, Co. Offaly, R35 NY51, Ireland.,Graduate Entry Medical School, University of Limerick, Castletroy, Limerick, V94 T9PX, Ireland
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Anderson PM, Hanna R. Defining Moments: Making Time for Virtual Visits and Catalyzing Better Cancer Care. HEALTH COMMUNICATION 2020; 35:787-791. [PMID: 30907145 DOI: 10.1080/10410236.2019.1587695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Time is quite possibly a physician's most valuable asset, yet the tendency of almost all physicians is to be overly committed. How do we slowdown and make a meaningful difference? Virtual visits provide a new way to share and care without sacrificing the important nuances of face-to-face communication. When the Cleveland Clinic expanded our Distance Health capabilities in 2017 using virtual visits, we began a successful journey which provides cancer patients and their caregivers a new type of expert, unrushed cancer care access. This essay describes our current process for providing virtual visit access, preparing prior to the visit, keeping the visit as informative a possible, and closing the visit with a "distance health encounter" in the electronic medical record coupled with a summary and additional information via email.
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Affiliation(s)
- Peter M Anderson
- Pediatric Hematology/Oncology and Bone Marrow Transplantation, Pediatrics Institute and Taussig Cancer Institute
| | - Rabi Hanna
- Pediatric Hematology/Oncology and Bone Marrow Transplantation, Pediatrics Institute and Taussig Cancer Institute
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Mole G, Murali M, Carter S, Gore D, Broadhurst J, Moore T, Vickers P, Miles A. A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery. ACTA ACUST UNITED AC 2020; 28:1234-1238. [PMID: 31680571 DOI: 10.12968/bjon.2019.28.19.1234] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. METHODS the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. RESULTS feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. DISCUSSION this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.
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Affiliation(s)
- Guy Mole
- National Medical Directors Clinical Fellow, NHS England, London, UK
| | - Mayur Murali
- National Medical Directors Clinical Fellow, NHS England, London, UK
| | - Sarah Carter
- Specialist Colorectal Nurse, Department of Colorectal Surgery, Royal Hampshire Hospital, Winchester, UK
| | - David Gore
- Consultant Colorectal Surgeon, Department of Colorectal Surgery, Royal Hampshire Hospital, Winchester, UK
| | - Jack Broadhurst
- Consultant Colorectal Surgeon, Department of Colorectal Surgery, Royal Hampshire Hospital, Winchester, UK
| | - Tim Moore
- Consultant Colorectal Surgeon, Department of Colorectal Surgery, Royal Hampshire Hospital, Winchester, UK
| | - Philip Vickers
- Senior Policy Analyst and Economist, British Columbia Ministry of Health, Victoria, Canada
| | - Andrew Miles
- Consultant Colorectal Surgeon, Department of Colorectal Surgery, Royal Hampshire Hospital, Winchester, UK
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Round T, Abel G. Seeing the wood and the trees: the impact of the healthcare system on variation in primary care referrals. BMJ Qual Saf 2019; 29:274-276. [PMID: 31822513 DOI: 10.1136/bmjqs-2019-010356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Thomas Round
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Gary Abel
- Medical School (Primary Care), University of Exeter, Exeter, UK
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Tung S, Davis LE, Hallet J, Mavros MN, Mahar AL, Bubis LD, Hammad A, Zhao H, Earle CC, Barbera L, Coburn NG, Siqqidui M, Li Q, Elmi M, Shin E, Hsieh E, Goyert N. Population-Level Symptom Assessment Following Pancreaticoduodenectomy for Adenocarcinoma. JAMA Surg 2019; 154:e193348. [PMID: 31483457 DOI: 10.1001/jamasurg.2019.3348] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Postoperative morbidity associated with pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PA) remains as high as 70%. However, to our knowledge, few studies have examined quality of life in this patient population. Objective To identify symptom burden and trajectories and factors associated with high symptom burden following PD for PA. Design, Setting, and Participants This population-based cohort study of patients undergoing PD for PA diagnosed between 2009 and 2015 linked population-level administrative health care data to routinely prospectively collected Edmonton Symptom Assessment System (ESAS) scores from 2009 to 2015, with a data analysis undertaken in 2018. Exposures Baseline characteristics, including age, sex, income quintile, rurality, immigration status, and comorbidity burden, as well as treatment characteristics, including year of surgery and receipt of chemotherapy. Main Outcome and Measures The outcome of interest was moderate to severe symptoms (defined as ESAS ≥4) for anxiety, depression, drowsiness, lack of appetite, nausea, pain, shortness of breath, tiredness, and impaired well-being. The monthly prevalence of moderate to severe symptoms was presented graphically for each symptom. Multivariable regression models identified factors associated with the reporting of moderate to severe symptoms. Results We analyzed 6058 individual symptom assessments among 615 patients with PA who underwent resection (285 women [46.3%]) with ESAS data. Tiredness (443 [72%]), impaired well-being (418 [68%]), and lack of appetite (400 [65%]) were most commonly reported as moderate to severe. The proportion of patients with moderate to severe symptoms was highest immediately after surgery (range, 14%-66% per symptom) and decreased over time, stabilizing around 3 months (range, 8%-42% per symptom). Female sex, higher comorbidity, and lower income were associated with a higher risk of reporting moderate to severe symptoms. Receipt of adjuvant chemotherapy was not associated with the risk of moderate to severe symptoms. Conclusions and Relevance There is a high prevalence of symptoms following PD for PA, with improvement over the first 3 months following surgery. In what to our knowledge is the largest cohort reporting on symptom burden for this population, we have identified factors associated with symptom severity. These findings will aid in managing patients' perioperative expectations and designing strategies to improve targeted symptom management.
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Affiliation(s)
- Stephanie Tung
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Laura E Davis
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michail N Mavros
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lev D Bubis
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Hammad
- Department of General Surgery, Mansoura University, Mansoura, Egypt
| | - Haoyu Zhao
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Craig C Earle
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Barbera
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Mina Siqqidui
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Qing Li
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maryam Elmi
- Division of Surgical Oncology, University of Texas Health Science Center, San Antonio
| | - Elizabeth Shin
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Hsieh
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Nik Goyert
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Evans HL. Executive Summary of the Assessing Surgical Site Infection Surveillance Technologies (ASSIST) Project. Surg Infect (Larchmt) 2019; 20:527-529. [PMID: 31335255 PMCID: PMC6823880 DOI: 10.1089/sur.2019.171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The expert panel that conducted the Assessing Surgical Site Infection Surveillance Technologies (ASSIST) project elaborates on the key findings of the health technologies assessment (HTA) report in a series of articles addressing topics from workflow challenges to implementation strategies to new big data analytics tailored to incorporate serial patient-generated health data (PGHD). Conclusion: By reporting on the methodology, with an emphasis on stakeholder engagement, the ASSIST investigators provide the basis for a future deep dive into the next phase of PGHD integration into surgical site infection (SSI) surveillance.
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Affiliation(s)
- Heather L. Evans
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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Cornejo-Palma D, Urbach DR. Virtual postoperative clinic: can we push virtual postoperative care further upstream? BMJ Qual Saf 2018; 28:7-9. [DOI: 10.1136/bmjqs-2018-008697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 11/04/2022]
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