Outpatients General Surgery Virtual Clinic Clinical Trial
Official title:
Can A Virtual Clinic Review Replace A Surgical Clinic Visit After Discharge?
To assess if a virtual out patient clinic via a telephone review was an acceptable and safe alternative to a clinic attendance for a broad range of general surgical patients discharged following a hospital admission.
The surgical out patients is often the first point of contact between a surgeon and patient
after being referred by their general practitioner (GP). Here new patients are assessed,
investigations are requested and treatment plans devised. On completion of treatment it has
been common practice to review all patients post operatively (1). However the routine review
of patients following low risk procedures contribute to increasing healthcare costs without
necessarily a significant benefit for the patient. It may indeed be a burden on patients and
families, who may miss work or college, have to travel long distances and wait for prolonged
periods to be seen. There is also a financial burden associated with travel to appointments
and on-site parking fees. Unnecessary appointments also contribute to increased waiting
times for new referrals to be seen. This has the potential to lead to delayed diagnosis of
serious conditions (2) and further increase the workload of overburdened emergency
departments.
Previous studies have demonstrated a safe and acceptable alternative to traditional
outpatient appointments with telephone follow up in certain paediatric and adult surgical
patients (1,3,4). Improved efficiency and high levels of patient satisfaction have also been
demonstrated in an Irish setting with the establishment of a virtual outpatient department
(VOPD) following endoscopy (5). In an oncology setting telephone follow up has also been
identified as an effective means of delivering care (6,7). In particular nurse led follow up
of lung, breast and colorectal cancer patients has been associated with a high level of
patient satisfaction (8).
The aim of this study was to determine whether a virtual out patient clinic via a telephone
review was an acceptable and safe alternative to a clinic attendance for a broad range of
general surgical patients discharged following a hospital admission.
If eligible for inclusion the patient was approached prior to discharge and the study
rationale, randomisation and methods of follow up were explained. If they agreed to
participate written consent was obtained and an information leaflet about the study was
provided. Randomisation was performed by selecting an unmarked white envelope which
contained either a coloured card indicating a telephone call follow up within 6-8 weeks or a
white card indicating follow up with an outpatient appointment at 6-8 weeks.
After randomisation the patient was provided with a letter detailing their specific follow
up arrangements and a contact number was provided if they had any further questions after
discharge. Patients' were sent a further letter by administration staff after discharge,
with the specific date of either the clinic appointment or phone follow up.
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