Towards NHS Zero: greener gastroenterology and the impact of virtual clinics on carbon emissions and patient outcomes. A multisite, observational, cross-sectional study

Objective

The National Health Service (NHS) produces more carbon emissions than any public sector organisation in England. In 2020, it became the first health service worldwide to commit to becoming carbon net zero, the same year as the COVID-19 pandemic forced healthcare systems globally to rapidly adapt service delivery. As part of this, outpatient appointments became largely remote. Although the environmental benefit of this change may seem intuitive the impact on patient outcomes must remain a priority. Previous studies have evaluated the impact of telemedicine on emission reduction and patient outcomes but never before in the gastroenterology outpatient setting.

Method

2140 appointments from general gastroenterology clinics across 11 Trusts were retrospectively analysed prior to and during the pandemic. 100 consecutive appointments during two periods of time, from 1 June 2019 (prepandemic) to 1 June 2020 (during the pandemic), were used. Patients were telephoned to confirm the mode of transport used to attend their appointment and electronic patient records reviewed to assess did-not-attend (DNA) rates, 90-day admission rates and 90-day mortality rates.

Results

Remote consultations greatly reduced the carbon emissions associated with each appointment. Although more patients DNA their remote consultations and doctors more frequently requested follow-up blood tests when reviewing patients face-to-face, there was no significant difference in patient 90-day admissions or mortality when consultations were remote.

Conclusion

Teleconsultations can provide patients with a flexible and safe means of being reviewed in outpatient clinics while simultaneously having a major impact on the reduction of carbon emissions created by the NHS.

Prediction of spontaneous preterm birth using quantitative fetal fibronectin after recent sexual intercourse

OBJECTIVE

The purpose of this study was to determine the effect of sexual intercourse on the accuracy of quantitative fetal fibronectin (qfFN) in the prediction of spontaneous preterm birth (sPTB) in asymptomatic high-risk women.

STUDY DESIGN

This was a prospective masked predefined subanalysis of a larger study of cervicovaginal fluid qfFN concentration in high-risk women asymptomatic of preterm labor. Women who had sexual intercourse within 48 hours of qfFN testing (n = 61; 18(+0)-34(+6) weeks' gestation) were compared with controls from the same database without a history of pretest sexual intercourse, matched according to gestational age at testing and delivery, risk factor for sPTB, and ultrasonographic cervical length measurement.

RESULTS

The median concentration of qfFN in women who had sexual intercourse within 48 hours of testing was 53 ng/mL (quartiles 6, 189), compared with 5 ng/mL (quartiles 2, 12) in the control group. The average qfFN concentration was 6.36 (95% confidence interval [CI], 3.43-11.8) times higher in the sexual intercourse group compared with controls (P < .0001). The false-positive rate was 56% (27 of 50) compared with 6% (3 of 52) in the control group (risk difference, 48%; 95% CI, 33-63; P < .001). The false-negative rate was 45% (5 of 11) vs 89% (8 of 9) in the control group (risk difference, -43%; 95% CI, -79 to -8; P = .043).

CONCLUSION

Sexual intercourse within 48 hours of testing is associated with increased levels of fetal fibronectin in vaginal secretions and an increased rate of false-positive results in the prediction of sPTB in asymptomatic women.