Background The declaration of a nationwide COVID-19 lockdown resulted in rapid adaptations to the NHS, including Paediatric Outpatient Consultations. At short notice, many Trusts converted consultations in General Paediatric outpatients from traditional face-to-face to telephone consultations. General Practitioners have been using this method of assessment, with the backing of the British Medical Association, as a safe and acceptable practice for many years.
Objectives We set out to perform a retrospective review of the lessons learned from Paediatric outpatient telephone consultations during COVID-19 and how these can be applied to improve the outpatient clinical pathway. Our aims and objectives evaluated:
The proportion of patients successfully contacted by telephone.
The proportion of presenting complaints which had resolved by the time of the appointment.
The proportion of patients who could be discharged from the General Paediatric clinic through telephone consultation.
The number of patients who we arranged to see in a face-to-face appointment within a few weeks (as deemed necessary by the phoning clinician).
The number of patients who needed further investigations.
Methods Two registrars (ST6+) and one senior house officer (ST2), with guidance from a dedicated General Paediatric Consultant, was assigned to conduct telephone consultations for all new patients booked into General Paediatric clinics between the 24/03/2020 to 31/05/2020. Most patients had been referred and appointments booked pre-COVID but urgent (2 -week) referrals from GPs were also seen.
Patients/parents/carers were called at least 3 times on 3 different occasions over at least 2 days. If they did not answer they were listed as ‘was not brought’. Calls were made between 9am to 5pm Monday to Friday.
Results 262 new patients had new General Paediatric Clinic appointments and 235 (90%) were successfully contacted. 27 (10%) of patients ‘were not brought’. These 27 patients were excluded from on-going analysis.
Following one telephone consultation, 105 (45%) contacted patients could be discharged from the General Paediatric clinic with parental agreement. Of these 27 (11%) patients had a complaint which had resolved by the time of the appointment and 19 (8%) patients had already been seen by a private consultant or other NHS consultant. Thus 46 (20%) of the contacted patients did not need their General Paediatric appointment.
Only 7 (3%) patients needed urgent face-to face-review of which 4 were urgent 2-week wait referrals by the GP. 155 (66%) patients needed no investigations.
Conclusions The NHS is going through unchartered, challenging time. However, this provides opportunities to adapt and evolve services, improving efficiency of care for both the families we look after and health service staff. The data above highlights that almost half of the new General Paediatric outpatients could be successfully discharged from clinic after one telephone consultation. During a time of significant anxiety and uncertainty families avoided hospital contact. A similar system when we return to normality could lead to fewer absences from school and less time off work for parents. Out experience suggests that initial telephone consultations with new General Paediatric patients may be an efficient way to make first patient contact.
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