Outpatient Clinic Appointments Research Articles

The Development and Feasibility of a Novel Electronic Patient-Reported Outcome Measures (Eproms) Questionnaire in patients with penile cancer

BackgroundPenile cancer (PeCa) is a rare cancer with surgical options that affect patients’ quality-of-life. Patient-reported outcome measures (PROMs) are uncommonly utilized in this cohort despite their several patient-centered benefits and there are recommendations to further digitalize PROMs. This prospective, population-based study aimed to report the development and feasibility of a novel electronic patient-reported outcome measures (ePROMs) questionnaire for patients with PeCa. Materials and methodsA novel ePROMs questionnaire was developed and sent to patients 3 days before outpatient clinic appointments. The questionnaire included up to 30 items on patient symptomology and quality-of-life, including a self-reported quality-of-life score (rated 0 being worst and 100 being best). Data were collected for patients followed up between August 2021 and May 2022. The primary feasibility outcomes, adherence and engagement, were measured by response and drop-out rates. Differences in responders and nonresponders were also ascertained. Secondary outcomes explored the clinical utility of the questionnaire. Responders were subcategorized into 3 groups: circumcision (Ci), partial penectomy (PP) or total penectomy (TP) and differences were analyzed. This study was approved by the local Trust Governance Panel, including for ethical considerations. Results220 adult males were sent ePROMs questionnaires, and 141 (64%) responded initially. The mean dropout rate of subsequent questionnaires was 56%. The maximum number of questionnaires sent to and completed by a patient was 8 (n = 1). Nonresponders were older (P < .0001), with poorer performance status (P < .0001) and lower body mass index (P = .0288). TP patients reported the lowest median quality-of-life score 68.50 (8-99), followed by the Ci group (72.0, 37-94) and the PP group (76.0, 10-99). ConclusionsPatients initially engaged and adhered to the ePROMs questionnaire but struggled to maintain this over time. Clinical data gathered by the questionnaire may be utilized to inform patient care. The questionnaire requires additional validation, research, and education.

Comparison of 30-day retention in treatment among patients referred to opioid use disorder treatment from emergency department and telemedicine settings

IntroductionTelemedicine is a feasible alternative to in-person evaluations for people with opioid use disorder (OUD). The literature on medications for opioid use disorder (MOUD) telemedicine has focused on ongoing OUD treatment. Emergency department (ED) visits are an opportunity to initiate MOUD; however, little is known regarding the outcomes of patients following telemedicine referrals for MOUD from emergency settings. The current study describes rates of initial outpatient clinic appointment attendance and 30-day retention in care among patients referred by telemedicine compared to ED referrals. MethodsThis paper reports a retrospective review of data for patients referred from EDs or telemedicine through the Medication for Addiction Treatment and Electronic Referrals (MATTERS) Network. The MATTERS online platform collects data on patient demographic information (e.g., age, gender, race/ethnicity, and insurance type), reason for visit, prior medical and mental health history, prior OUD treatment history, and past 30-day substance use behaviors. Analyses compared initial visit attendance and 30-day retention among the patients for whom follow-up data were received from clinics by demographic and initial treatment factors. ResultsBetween October 2020 and September 2022, the MATTERS Network made 1349 referrals; 39.7 % originated from an ED and 47.8 % originated from telemedicine. For patients with available data, those referred from telemedicine were 1.64 times more likely to attend their initial clinic appointment and 2.59 times more likely be engaged in treatment at 30 days compared to those referred from an ED. More than two-thirds of patients referred from the emergency telemedicine environment followed up at their first clinic visit and more than half of these patients were still retained in treatment 30 days after referral. ConclusionsThe rates of initial clinic visit and 30-day retention when referred following a telemedicine evaluation are encouraging. Further development of telemedicine programs that offer evaluations, access to medications, and referrals to treatment should be considered.

Characteristics of the Basel Postpartum Hypertension Cohort (Basel-PPHT Cohort): An Interim Analysis.

Postpartum hypertension (PPHT) is hypertension that persists or develops after delivery and is a frequent cause of readmission, affecting 10% of pregnancies. This interim analysis aims to describe the cohort and to determine the feasibility and acceptance of a home-based telemonitoring management strategy (HBTMS) in PPHT patients. Enrollment at the University Hospital Basel began during the 2020 SARS-CoV-2 pandemic. Maternity-ward patients were screened for preexisting hypertension, hypertensive disorders of pregnancy, and de novo PPHT. In this pragmatic non-randomized prospective trial, the participants chose the HBTMS or standard of care (SOC), which consisted of outpatient hypertension clinic appointments. The HBTMS was a smartphone application or a programmed spreadsheet to report blood pressure (BP), followed by telephone consultations. Three months postpartum, the participants underwent a 24 h BP measurement and a blood, biomarker, and urine analysis. A total of 311 participants were enrolled between 06/20 and 08/23. The mean age was 34 (±5.3) years. The current pregnancy history demonstrated the following (≥1 diagnosis possible): 10% had preexisting hypertension, 27.3% gestational hypertension, 53% preeclampsia (PE), 0.3% eclampsia, 6% HELLP (hemolysis, elevated liver enzymes, and low platelets), and 18.3% de novo PPHT. A family history of cardiovascular disease and PE was reported in 49.5% and 7.5%, respectively. In total, 23.3% were high-risk for PE. A total of 68.5% delivered via c-section, the mean hospitalization was 6.3 days (±3.9), and newborn intrauterine growth restriction occurred in 21%. A total of 99% of the participants chose the HBTMS. This analysis demonstrated that the HBTMS was accepted. This is vital in the immediate postpartum period and pertinent when the exposure of hospital visits should be avoided.

Deferring diagnostic evaluation of suspected deep vein thrombosis using direct oral anticoagulant or low-molecular-weight heparin as a single dose anticoagulant: A prospective real-world study in a regionwide care pathway

BackgroundPatients with suspected deep vein thrombosis (DVT) are typically referred to the emergency department for immediate evaluation. To enhance efficiency, our hospital implemented a regional, general practitioner (GP)-driven DVT care pathway, deferring diagnostic evaluation to a scheduled outpatient DVT clinic appointment the following day. Patients receive a single dose anticoagulant from their GP to prevent thrombosis progression while awaiting diagnostic workup. This prospective study aimed to evaluate the safety and patient preferences regarding the DVT care pathway and the type of single dose anticoagulant (low-molecular-weight heparin (LMWH) vs. direct oral anticoagulant (DOAC)). MethodsPatients enrolled in the DVT care pathway between June 2021 and July 2023 were eligible. Until July 2022, LMWH was administered, and thereafter, the protocol recommended DOAC as the single dose anticoagulant. Patients completed questionnaires, incorporating patient-reported outcome and experience measures (PROMs/PREMs), during their DVT clinic visit and after five days. The primary endpoint was bleeding events within 72 h of receiving the single dose anticoagulant. ResultsOf 460 included patients, 229 received LMWH and 231 received DOAC as the single dose anticoagulant. DVT was confirmed in 24.8 % of patients. No major or clinically relevant non-major bleeding were reported. LMWH was associated with more minor bleedings (22.3 % vs. DOAC 13.4 %), primarily attributed to injection site hematomas. Patients reported high satisfaction with the DVT care pathway (96.5 %) and generally preferred DOAC over LMWH. ConclusionDeferring diagnostic evaluation for DVT using a single dose of either LMWH or DOAC in a real-world population is deemed safe. Considering practical advantages, patient preferences, and fewer skin hematomas, we favor DOACs as the single dose anticoagulant in this care pathway.

#841 Healthcare workload amongst people with chronic kidney disease: what impact do mental disorders have?

Abstract Background and Aims People with chronic kidney disease (CKD) often experience a high healthcare workload in the form of medication management, contacts with healthcare services, and other tasks. Co-existing health conditions can increase healthcare workload, with mental disorders generating additional workload alongside physical conditions. We hypothesised that mental disorders in people with CKD would be common and that healthcare workload would be elevated for people with mental disorders. Method Data were used from the Secure Anonymised Information Linkage Databank: primary care data for people living in Wales, UK, with linkage to hospital records. We studied adults over the age of 18 with CKD G3-5 not on kidney replacement therapy. We defined “mental disorder” as any primary care-recorded diagnosis of anxiety, depression, eating disorders, schizophrenia, and/or bipolar disorder. We estimated healthcare workload by quantifying visits to accident and emergency (A&amp;E), days spent in hospital during emergency admissions (general hospitals and psychiatric hospitals), number of outpatient clinic appointments, locations of clinic appointments, and number of long-term medications prescribed. We estimated associations between mental disorders and healthcare workload using negative binomial models, making adjustments for age, sex, diabetes, ischaemic heart disease, smoking status, and socioeconomic deprivation. Results Of 173 388 people with CKD, mean age was 77 years, 54 537 (31.5%) had one or more mental disorder and 20 374 (11.8%) had two or more. Over a median follow-up period of 5.5 years, people with CKD and mental disorders spent a median 1.9 days in hospital (interquartile interval [IQI] 0.0 to 14.7) compared to people with CKD without mental disorders: 1.0 (IQI 0.0 to 9.9) days. People with CKD and mental disorders attended a median of 2.6 clinics (IQI 1.0 to 5.5) compared to people with CKD without mental disorders: 2.3 (IQI 0.8 to 4.9). The presence of any mental disorder was associated with more days spent in hospital: adjusted rate ratio (aRR) 1.58 (95% confidence interval 1.54-1.62), more A&amp;E attendances: aRR 1.37 (1.35-1.39) and more clinic appointments: aRR 1.13 (1.11-1.14). The association with hospital days was strongest for people with eating disorders: aRR 3.70 (2.50-5.49). People with any mental disorder attended a similar number of locations for clinics than those without mental disorders: median 2 for both groups (IQI 1 to 3). However, people with schizophrenia, bipolar disorder or eating disorders attended more locations: median 3 (IQI 2 to 4). People with mental disorders took more medications (median 9: IQI 6 to 13) than those without mental disorders (median 7: IQI 4 to 10). Conclusion Mental disorders are common amongst people with CKD and healthcare workload is greater for people with than without mental disorders. Although a proportion of the increased healthcare workload might be expected (such as people taking medications for their mental health), the additional days spent in hospital is a notable finding. This may reflect problems with how these people experience healthcare and it is likely to have an impact on their quality of life. Targeted work is required to understand the specific healthcare needs of people with CKD and mental health disorders.

Evaluating the Impact of the COVID-19 Pandemic on Late-Canceled and No-Show Appointments at the Department of Neurological Surgery.

The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented restrictions on the general public and disturbances to the routines of hospitals worldwide. These restrictions are now being relaxed as the number of vaccinated individuals increases and as the rates of incidence and prevalence decrease; however, they left a lasting impact on healthcare systems that is still being felt today. This retrospective study evaluated the total number of canceled or missed outpatient clinic appointments in a Neurological Surgery department before and after peak COVID-19 restrictions and attempted to assess the impact of these disruptions on neurosurgical clinical attendance. We also attempted to compare our data with the data from another surgical subspecialty department. We evaluated 32,558 scheduled appointments at the Loyola University Medical Center Department of Neurological Surgery, as well as 139,435 scheduled appointments with the Department of Otolaryngology. Appointments before April 2020 were defined as pre-COVID, while appointments during or after April 2020 were defined as post-COVID. Here, we compare no-show and non-attendance rates (no-shows plus late-canceled appointments) within the respective time range. Overall, we observed that before COVID-19 restrictions were put into place, there was an 8.9% no-show rate and a 17.4% non-attendance rate for the Department of Neurological Surgery. After COVID restrictions were implemented, these increased to 10.9% and 18.3%, respectively.Greater no-show and cancellation rates (9.8% in the post-COVID era vs 8.0% in the pre-COVID era) were associated with varying socioeconomic and racial demographics. African-American patients (2.56 times higher), new-visit patients (1.67 times higher), and those with Medicaid/Medicare insurance policies (1.48 times higher) were at the highest risk of no-show in the post-COVID era compared to the pre-COVID era.

Effect of Financial Penalties on Appointment Nonadherence in Academic Obstetrics and Gynecology Clinics [ID 2683433

INTRODUCTION: The objective of this study was to examine the effect of patient financial penalties on appointment nonadherence within a single academic institution's obstetrics and gynecology outpatient clinics. METHODS: This retrospective policy effectiveness-implementation hybrid study included administrative data from all appointments at a single academic institution’s obstetrics and gynecology outpatient clinics from May 1, 2018, to April 30, 2022. Institutional review board approval was waived for this study. The department-wide patient financial penalty policy for appointment nonadherence was implemented on May 1, 2020. We conducted an interrupted time series analysis after stratifying by insurance (Medicaid versus all insurance). Poisson regression was used to calculate incidence risk ratios (IRRs) with 95% CIs. RESULTS: There were 414,006 obstetrics and gynecology outpatient clinic appointments (pre-implementation [pre]: 208,696; post-implementation [post]: 205,410). Of these, 58,473 (14.1%; pre: 29,533 [14.2%]; post: 28,940 [14.1%]) appointments were not attended. Compared to the all insurance group, Medicaid patients had a higher rate of appointment nonadherence (36,872/188,343 [19.6%]; pre: 18,070 [19.6%]; post: 18,802 [19.6%]). In the all insurance group, the implementation of financial penalties resulted in a 4% increase in nonadherence (IRR 1.04 [95% CI, 0.99–1.09]). In the Medicaid group, the implementation of financial penalties did not change nonadherence (IRR 1.00 [95% CI, 0.98–1.02]). There was no significant difference in the coefficient between Medicaid and all insurance groups (P&gt;.05). CONCLUSION: Institutional implementation of patient financial penalties for appointment nonadherence did not change appointment nonadherence rates in obstetrics and gynecology outpatient clinics. The lack of change persisted after stratifying by insurance despite the inability to charge Medicaid patients a financial penalty for appointment nonadherence.

P065 Patient-initiated follow up in rheumatoid arthritis: a systematic review and meta-analysis

Abstract Background/Aims Inflammatory arthritides including rheumatoid arthritis (RA) typically require lifelong outpatient care. Patient-initiated follow up (PIFU) has been employed to alleviate burdens on over-stretched rheumatology clinics, aiming to eliminate unnecessary clinic visits and reduce waiting times. There is a paucity of robust data to establish whether clinical outcomes differ under PIFU compared to clinician-mandated follow up. We examined the effect of PIFU on key outcomes in patients with inflammatory arthritis. Methods We searched MEDLINE, Embase, PsycInfo and CENTRAL for randomised controlled trials comparing PIFU (and similar patient-directed strategies) with clinician-mandated follow up in patients with inflammatory arthritis. Publications were screened in accordance with PRISMA guidelines and included based on pre-specified criteria. Risk of bias was assessed using the Cochrane ROB2 tool. Outcome measures analysed were disease activity, serum C-reactive protein, disability, service use and satisfaction with care. Standardised mean differences (SMD) were used to account for variable use of outcome measures between papers. Results Six studies were included with a total of 1,059 patients, all of whom had RA, followed up for between one and six years. Two trials were conducted in Denmark, two in the UK and one each in Sweden and the Netherlands. Two involved two sites; four were single centre. Three studies were deemed to be at high risk of bias, two at moderate risk and one at low risk. The data demonstrated a reduced burden of clinic visits for patients under PIFU (all studies; SMD -0.56, [95% CI -0.85 to -0.28]) equivalent to a reduction in approximately one clinic visit for every two patients over the course of the study period. This was balanced by an increased number of telephone consultations (4 studies, 817 patients; SMD 0.40 [0.13 to 0.66]) equating to an extra consultation per 2.5 patients under PIFU. Non-significant trends were seen towards higher patient satisfaction (all studies; SMD 0.28 [-0.12 to 0.68]) for patients under PIFU. However, there were also trends towards higher CRP (three studies, 490 patients; SMD 0.22 [-0.08, 0.52]) and DAS28 score (4 studies, 658 patients; SMD 0.08[-0.20, 0.36]. No significant difference was seen in patient-reported disability. There was substantial statistical heterogeneity between studies. Conclusion PIFU is associated with a reduction in outpatient clinic appointments but increased numbers of telephone consultations, while maintaining patient satisfaction. Current data do not exclude the possibility of inferior long-term clinical outcomes for patients receiving PIFU. Transition to PIFU risks reducing services’ capacity to assess and modify clinically important parameters (e.g. cardiovascular risk) through regular scheduled review. These studies highlight the challenges in conducting meaningful trials on this question due to the heterogeneity of interventions and outcomes and the already-widespread use of some aspects of PIFU in routine care. Disclosure E. Alveyn: Other; Educational support from UCB. R. Crowder: None. M. Perry: None. S. Norton: None. J. Galloway: Honoraria; from AbbVie, Celgene, Chugai, Gilead, Janssen, Eli Lilly, Pfizer, Roche and UCB.

Different anatomical variations in the anterior segment of the right upper lung

During a routine physical examination three years ago, a 47-year-old woman received a diagnosis of a nodule in her right upper lung. Since then, she has been regularly attending outpatient clinic appointments for follow-up. Over time, the nodule has shown gradual growth, leading to a suspicion of lung cancer. Through the use of enhanced CT imaging, a three-dimensional reconstruction was performed to examine the bronchi and blood vessels in the patient’s chest. This reconstruction revealed several variations in the anatomy of the anterior segment of the right upper lobe. Specifically, the anterior segmental bronchus (B3) was found to have originated from the right middle lung bronchus. Additionally, the medial subsegmental artery of the anterior segmental artery (A3b) and the medial segmental artery (A5) were observed to share a common trunk. As for the lateral subsegmental artery of the anterior segmental artery (A3a), it was found to have originated from the right inferior pulmonary trunk. Furthermore, the apical subsegmental artery of the apical segmental artery (A1a) and the posterior segmental artery (A2) were found to have a shared trunk.

BEEC psychosocial screening at Royal Manchester Children's Hospital

Bladder Exstrophy and Epispadias Complex (BEEC) is associated with psychosocial difficulties. Screening questionnaires, alongside consultation with a clinical psychologist, can help identify children/young people for further assessment and track trends over time to improve service delivery. To screen paediatric BEEC patients for a range of general psychosocial difficulties in a multi-disciplinary out-patient clinic setting and compare these results with our previous study and against published norms. The current service evaluation collected data at outpatient BEEC clinic appointments between 2016 and 2022 (2016-2022 sample). Children aged 4-5, 10-11 and 14-15 years and their parents/proxy were asked to complete two standardised psychosocial questionnaires: Paediatric Quality of Life Inventory (PedsQL 4.0 Generic Core and Family Impact Module) and the Strengths and Difficulties Questionnaires (SDQ). 79 children (CYP) and 93 parent/proxy (P/P) responses were recorded. The sample included paired CYP and P/P responses for the PedsQL (n=67) and SDQ (n=35). The mean age for CYP was 9.9 years (SD 3.99, range 2-17), 69.8% (n=120) of responses for male children. The percentage of total CYP scores falling within the 'At Risk' category on the PedsQL increased in the 2016-2022 sample compared to our 2015 sample, indicating the prevalence of greater difficulties. Differences between P/P and CYP responses on both the PedsQL and SDQ favoured CYP. Age, gender, and diagnosis appeared to influence certain questionnaire responses, depending on respondent (CYP or P/P). A significant difference between P/P and CYP in the emotional domain of the PedsQL for those aged 13-18 was observed (p=0.020), with P/P reporting greater difficulties, but this was not seen in the younger age ranges. Physical Health on the PedsQL were significantly lower for children with a cloacal exstrophy diagnosis, in comparison to bladder exstrophy and epispadias. P/P SDQ scores for boys were significantly higher in several domains. The results demonstrate the need for psychosocial screening, providing benchmarking for psychosocial difficulties within this patient group. Results indicate that patients accessing our clinic are reporting a higher level of challenge across psychosocial domains in recent years reflected by the percentage within the 'At Risk' category for psychosocial difficulty. Linked questionnaire data with condition specific information and surgical history would improve service evaluations. CYP reaching clinical thresholds are offered further psychological assessment within the service.

How practitioner-led colonoscopy surveillance management improves productivity while saving money

Background: The British Society for Gastroenterology (BSG) guidelines for post-polypectomy and post-cancer-resection surveillance were changed in October 2020, essentially excluding a large proportion of patients awaiting a surveillance colonoscopy as they now no longer fit the criteria for surveillance. Aims: To audit the colonoscopy surveillance waiting list at the Wye Valley Trust to ascertain patient appropriateness for colonoscopy under the new BSG guidelines. Methods: A practitioner-led colonoscopy surveillance clinic led by a clinical endoscopist was set up to audit the colonoscopy surveillance waiting list of over 1200 patients. The aim was to clinically assess each patient against the guidelines and determine discharge from, or continuation of, the surveillance pathway for each patient. The patients were then offered outpatient clinic appointments where fitness was assessed and appropriate investigations were finalised. Results: Patient numbers on the colonoscopy surveillance waiting list were reduced by nearly 50%, with waiting times down to 0 weeks, by facilitating practitioner-led pre-assessment and outpatient clinics, all while saving Weston General Hospital almost £300000 in the initial 9 months. Conclusions: The new colonoscopy surveillance guidelines presented an opportunity to audit and evaluate the colonoscopy guidelines in the Wye Valley Trust. The facilitation of a clinical endoscopist committed time to implement new pre-assessment processes and outpatient clinics, this process allowed the discharge of almost 50% of patients upon the colonoscopy surveillance waiting list, it created extra colonoscopy capacity for 2 week wait and urgent colonoscopies, while generating a positive financial implication for the trust.

Case Report: Urethral Diverticulum after Distal Hypospadias Repair: An Uncommon Complication.

Abstract* Introduction A urethral diverticulum can be defined as a pocket that forms from the lining of the urethra and protrudes into the surrounding tissue, a condition which causes voiding dysfunction and may result as a rare complication of hypospadias repair surgery. Case report We report the case of a 2-year-old child who presented to us in 2019 complaining of a thin forceful stream, ballooning of the ventral aspect of the penis while voiding, and post-void dribbling. He has a history of undergoing a tabularised incised plate urethroplasty for distal penile hypospadias at 18-months-old. Ultrasound showed increased post-void residual volume and cystourethroscopy confirmed a urethral diverticulum extending from the subcorona to the base of the penis. The patient underwent partial excision of diverticulum, urethroplasty, and meatoplasty. He was followed-up 3 months later with complete resolution of his symptoms and a normal urinary stream with no urethral ballooning or dribbling. Conclusion Urethral diverticulum may present as a complication post hypospadias repair. Although it is rare, we believe that it is important for the patient’s parents to understand the possibility and know of the signs and symptoms in addition to attending regular outpatient clinic appointments in order to facilitate early management if needed. Furthermore, it is highly important for physicians to assess newborns for hypospadias before carrying out circumcision as it is a contraindication for the procedure.

Perspectives of Women of Reproductive Age Regarding Sexuality During Their Menstruation Period

IntroductionThis study aimed to determine the views and experiences of women of reproductive age regarding their sexuality and sexual life during their menstrual period.MethodsA qualitative, interpretive, phenomenological design was used. The study sample consisted of 16 women of reproductive age (18–49), who volunteered to participate and came to gynecology outpatient clinic appointments at a research hospital in Istanbul, Turkey. Data were collected online through in-depth individual interviews.ResultsThe research was composed of six themes: “symptoms of the menstruation period,” “duration and severity of symptoms during menstruation,” “effect of the menstrual period on sexual life,” “sexual desire during the menstrual period,” “opinions about sexual life during menstruation,” and “spouses’ opinions about sexual life during menstruation.”ConclusionsThe women in the study noted that they experienced physiological and psychological symptoms during their menstrual period. Although some of the women stated that they do not have changes in sexual desire during this period, most of them think that they should not engage in sexual intercourse due to the symptoms they experience during their menstrual period, religious beliefs, and sociocultural values.Policy ImplicationsNurses should counsel couples about the possible advantages and disadvantages of sexual intercourse during menstruation without displaying a judgmental attitude.

The economic and resource burden of e-scooter-related orthopaedic injuries: A district general hospital's experience

PurposeElectric scooters (e-scooters) are an increasingly popular method of transportation worldwide. However, there are concerns regarding their safety, specifically with regards to orthopaedic injuries. We aimed to investigate the overall burden and financial impact on orthopaedic services as a result of e-scooter-related orthopaedic injuries. MethodsWe retrospectively identified all e-scooter-related injuries requiring orthopaedic admission or surgical intervention in a large District General Hospital in England over a 16-month period between September 2020 and December 2021. Injuries sustained, surgical management, inpatient stay and resources used were calculated. ResultsSeventy-nine patients presented with orthopaedic injuries as a result of e-scooter transportation with a mean age of 30.1 years (SD 11.6), of which 62 were males and 17 were females. A total of 86 individual orthopaedic injuries were sustained, with fractures being the most common type of injury. Of these, 23 patients required 28 individual surgical procedures. The combined theatre and recovery time of these procedures was 5500 min, while isolated operating time was 2088 min. The total cost of theatre running time for these patients was estimated at £77,000. A total of 17 patients required hospital admission under Trauma and Orthopaedics, which accounted for total combined stay of 99 days with a mean length of stay of 5.8 days. ConclusionWhile there are potential environmental benefits to e-scooters, we demonstrate the risks of injury associated with their use and the associated increased burden to the healthcare system through additional emergency attendances, frequent outpatient clinic appointments, surgical procedures, and hospital inpatient admissions.

The impact of the COVID-19 pandemic on rates and predictors of missed hospital appointments in multiple outpatient clinics of The Royal Hospital, Sultanate of Oman: a retrospective study

BackgroundThe global outbreak of the COVID-19 pandemic resulted in significant changes in the delivery of health care services such as attendance of scheduled outpatient hospital appointments. This study aimed to evaluate the impact of COVID-19 on the rate and predictors of missed hospital appointment in the Sultanate of Oman.MethodsA retrospective single-centre analysis was conducted to determine the effect of COVID-19 on missed hospital appointments at various clinics at The Royal Hospital (tertiary referral hospital) in Muscat, Sultanate of Oman. The study population included scheduled face-to-face and virtual appointments between January 2019 and March 2021. Logistic regression models were used with interaction terms (post COVID-19) to assess changes in the predictors of missed appointments.ResultsA total of 34, 3149 scheduled appointments was analysed (320,049 face-to-face and 23,100 virtual). The rate of missed face-to-face hospital appointments increased from 16.9% pre to 23.8% post start of COVID-19, particularly in early pandemic (40.5%). Missed hospital appointments were more frequent (32.2%) in virtual clinics (post COVID-19). Increases in missed face-to-face appointments varied by clinic (Paediatrics from 19.3% pre to 28.2% post; Surgery from 12.5% to 25.5%; Obstetrics & Gynaecology from 8.4% to 8.5%). A surge in the frequency of missed appointments was seen during national lockdowns for face-to-face and virtual appointments. Most predictors of missed appointments did not demonstrate any appreciable changes in effect (i.e., interaction term not statistically significant). Distance of patient residence to the hospital revealed no discernible changes in the relative effect pre and post COVID-19 for both face-to-face and virtual clinic appointments.ConclusionThe rate of missed visits in most clinics was directly impacted by COVID-19. The case mix of patients who missed their appointments did not change. Virtual appointments, introduced after start of the pandemic, also had substantial rates of missed appointments and cannot be viewed as the single approach that can overcome the problem of missing hospital appointments.

Telemedicine in specialist outpatient care during COVID-19: a qualitative study.

COVID-19 accelerated healthcare changes, introducing various telehealth services. Work is needed to determine the suitability of telemedicine in the post-pandemic era. To explore perceptions and experiences of telemedicine among patients and providers (clinicians and health administrators) who were involved in telemedicine appointments in hospital outpatient clinics in 2020-2022. Qualitative study: semi-structured interviews were conducted with 37 participants (16 patients and 21 providers) in various hospital specialist outpatient clinics in a New South Wales local health district. Patients were generally satisfied with telemedicine consultations, especially during COVID restrictions, because of the convenience of accessing care from home and minimising the risk of COVID exposure. However, patients considered that the inability to receive a physical examination was a significant disadvantage of telemedicine. Providers had ambivalent perceptions and expressed concerns about mis- and under-diagnoses because of the inability to conduct physical examinations. They considered telemedicine suitable for review appointments but noted an associated increased workload and stressed the need for sustainable funding models (Medicare items). Both patients and providers recognised the need for education/training and better integration of telemedicine platforms into existing infrastructure to facilitate an optimal hybrid model of care. Despite expressing some concerns over its limitations, patients valued telemedicine for its convenience and for meeting their needs during the pandemic. While acknowledging that patients experienced some benefits from telemedicine, clinicians expressed concerns about potential missed diagnoses, uncertain clinical outcomes and lack of administrative and technological infrastructure. The ultimate test of telemedicine will be its impact on clinical outcomes versus longstanding models of in-person care.

Clinician-created video education for patients with atrial fibrillation: a randomised clinical trial

Abstract Background Improved health literacy is associated with better health outcomes.(1) Atrial fibrillation (AF) is a complex condition and patient understanding of AF is poor.(2) There is little time during routine care to provide education on AF. Clinic waiting time provides an opportunity to deliver education that improves AF knowledge and engagement with clinical care. Purpose Assess the efficacy and feasibility of remotely-delivered clinician-created education for patients with AF. Methods Single-centre randomised clinical trial (ANZCTRN 12620000729921, registered 13/07/2020) conducted in adults over 18 years of age awaiting outpatient cardiac clinic appointments with electrocardiogram-confirmed AF, CHA²DS²VASc &amp;gt; 0 and an active electronic mailing address or mobile phone. Those with insufficient English proficiency to comprehend video content were excluded. Eligible participants were recruited remotely and randomised 1:1 to an internet-based intervention of 4 animated videos narrated by treating cardiologists totalling 15 minutes with the option to review videos weekly, or usual care. Recruiting staff, outcome assessors and those responsible for statistical analysis were blinded to treatment allocation. The primary outcome was Jessa AF Knowledge Questionnaire (JAKQ) score (a 16-item validated questionnaire consisting of general AF and anticoagulation-specific questions(2)) at 90 days post recruitment adjusted for baseline performance, AF diagnosis, educational level, age and sex. A sample size of 200, allowing for 15% attrition and a standard deviation of 18 described previously(2) was prospectively calculated to have 90% power (2-sided, type 1 error of 5%) to detect an 8.95% difference in 90-day AF knowledge. Results Between November 2020 and July 2022, 208 patients were randomised (104 intervention, 104 control). Mean (standard deviation) age was 65.0 (12) years, and 65.2% were male. Most (56.2%) had paroxysmal AF and 6.4% had first episode AF. Intervention participants were more likely to correctly answer JAKQ questions at 90 days (odds ratio [OR] 1.23 [95% confidence interval (CI) 1.01, 1.49]). Highly engaged participants were more likely to have higher JAKQ scores (OR 1.46 [95% CI 1.14, 1.88] among those who watched videos on 3 or more weeks compared to control). Video satisfaction was high (figure 2). There was no significant difference in satisfaction with care or education provided in clinic OR 1.32 [95% CI 0.71, 2.44]). Conclusions A clinician-created, low-cost, remotely-delivered educational intervention among patients with AF awaiting cardiac clinic appointments was highly acceptable and improved AF knowledge at 90 days. Increased intervention exposure correlated with higher knowledge scores. Future delivery of this intervention could investigate impact on medication adherence, AF burden, and patient-reported quality of life outcomes.Figure 1Figure 2

1161 The Financial Impact of Electric Scooter Orthopaedic Injuries at a Large District General Hospital in England

Abstract Aim Electric scooters are becoming an increasingly popular method of transportation in major urban cities worldwide. As their popularity gains, there are concerns about safety and injuries sustained, of which significant proportion are orthopaedic injuries. The aim of this study was to see the financial impact of e-scooter related orthopaedic injuries. Method In a retrospective study, we investigated the overall burden and the financial impact of the orthopaedic injuries as a result of the use of e-scooter transportation in a large District General Hospital in England over a 16-month period between September 2020 and December 2021. Results Seventy-nine patients were identified with a mean age of 30.1 years (SD 11.6). Sixty-two of these patients were males and seventeen were females. There were eighty-six orthopaedic injuries, with fractures being the most occurring type of injury. Twenty-three patients required twenty-eight different surgical procedures. The combined theatre and recovery time was 5500 minutes, while the surgical procedures operating time was 2088 minutes. The cost total cost of theatre running time for these patients was £77,000. Seventeen patients required hospital admission under Trauma and Orthopaedics, which accounted for total stay of ninety-nine days with a mean length of stay of 5.8 days per patient. Conclusions We have demonstrated that although there are environmental benefits to e-scooters; there have been a significant increase in healthcare system burden as demonstrated by additional emergency attendances, frequent outpatient clinic appointments, surgical procedures, and hospital inpatient admissions.

35 Enhanced Vetting of Urology Referrals in NHS Lanarkshire

Abstract Aim There is an unmatched need for outpatient clinic appointments across all specialties in the NHS. We aimed to reduce unnecessary clinic appointments within the Lanarkshire Urology Department and thus allow timely access to outpatient appointments for newly referred patients with greater clinical need. Method Following a successful pilot in December 2018 all referrals to Lanarkshire Urology department underwent an enhanced vetting process by a consultant urologist with particular attention to:Detailed review of electronic records and imagingBooking of scans/ repeat blood tests prior to consultationsSignposting to more appropriate services such as the community continence clinic were indicatedWritten advice, with returned referrals giving clear guidance and evidence-based recommendations where appropriate Subsequently 3 phases have been completed Phase 1: June-December 2019. Phase 2: June-December 2020. Phase 3: January - November 2021 Results Pilot and Phase 1 6.3% of referrals were clinically canceled with the referrer being sent case specific clinical advice. This increased to 9.5% in phase 1. Phase 2: There were 3012 outpatient urology referrals between June and December 2020. 762 patients were vetted as clinically canceled, an 87% increase from 2019, reducing the number of clinic appointments required by 25%. Phase 3: 9634 patients were referred between January 2021 and November 2021, 15.8% (n = 1484) vetted as clinically canceled/ advised only. Furthermore, 548 patients were taken straight to test decreasing duplicate appointments. Conclusions We have recognized that vetting is a factor that, done well, can mitigate unmatched demand in outpatient services.

Impact of Postponement of Appointments on Vision and Psychological Well-Being Among Outpatients Attending Ophthalmology Clinics: A Malaysian Perspective.

During the COVID-19 pandemic, non-frontline medical disciplines, including ophthalmology, were advised to minimize their services to channel crucial healthcare resources to manage the surge in COVID-19 cases. The ophthalmology department postponed allnon-urgentappointments and elective surgical procedures.However, little is known about thevisual and mental health impact of these changes in ophthalmology services. Therefore, our study aimed to explore the impact of postponement in ophthalmology outpatient clinic appointments towards visual acuity (VA) changes and the psychological well-being of patients during the COVID-19 pandemic in Malaysia. This cross-sectional study, utilizing a convenience sampling method, recruited patients attending ophthalmology outpatient clinic services from July 2020 to June 2021 to participate in the study. The Snellen chart was used to measure the VA, and the Kessler psychological distress scale (K-10) was used to measurepsychological distress levels among patients with (study) and without (controls) postponement of the appointment. Results: A total of 485 patients were included in the data analysis; 267 study and 218 controls. There is a statistically significant difference in categorical change of VA (p < 0.001) and categorical K-10 score (p = 0.048) among the study and control groups. Nonetheless, a decline in VA alone does not show a statistically significant association with an increased probability of experiencing psychological distress (p=0.149). Postponement of ophthalmology appointments negatively affected the VA and the psychological well-being of patients.Appropriate assessment of patients before postponing their appointment is crucial to mitigate the worsening of VA and psychological distress.