Telephone Clinic Research Articles

Effectiveness of telephone clinics for assessment of new onset chest pain - a retrospective single-centre observational study

Abstract Background The COVID-19 pandemic led to a significant shift in the way clinical consultations are conducted with a rapid transition towards remote consultations (teleclinics). Although face-to-face (F2F) clinics are being re-introduced in the post-pandemic era, a significant proportion of clinics continue to run remotely. Despite the inability to physically examine the patient, remote clinics have notable advantages such as increased accessibility and flexibility for both the clinician and the patient. Purpose As the healthcare model moves increasingly towards a hybrid system where both F2F and teleclinics coexist, we sought to analyse the differences in practice between the two groups. Methods This single-centre retrospective analysis of patients referred to specialist cardiology services with NOCP compared face-to-face (F2F) consultations with teleclinic consultations. 70 patients were randomly selected in each category from a list of patients with NOCP that were referred to a tertiary cardiac centre from January to December 2021. Teleclinic appointments were conducted via telephone while F2F clinics had the patients visit the hospital for their appointments. Results The main findings are tabulated in Table 1. The samples for the two categories were evenly matched. Teleclinic appointments had a significantly reduced waiting time compared to F2F clinic (4 vs 6 weeks, p= 0.0009). As expected, the teleclinic group had reduced access to examination findings such as blood pressure, heart rate, and ECG. There was no significant difference in an initial working diagnosis of typical angina between the F2F group and the teleclinic group (30% and 25.7% respectively, p=0.706). However, patients in the F2F group were more likely to have anti-anginal therapy commenced compared to teleclinic group (50% vs 27.1% respectively, p=0.0089) following initial clinic review. Also, they were more likely to undergo an invasive coronary angiogram (30% vs 12.9% in F2F and teleclinic groups respectively, p=0.0224). However, this did not lead to a significant increase in PCIs performed in the F2F group. More patients had non-invasive tests requested in the teleclinic group compared to the F2F clinic group (62.9% vs 50% respectively, p=0.17) although this was not significant the median number of total investigations requested were the same in both the group. Conclusion Telephone consultations appear to be a reasonable alternative to F2F consultations with reduced waiting times and no significant impact on investigations ordered. However, lack of key examination findings may have hampered prescription of anti-anginal medications. Provisions such as readily available access to GP health care records on examination findings along with a streamlined remote prescription system can help overcome reluctance to prescribe antianginals. Further research is needed to assess clinical outcomes of teleclinic consultations.Table 1

Development and early Evaluation of a novel tool for assessment of individualised risk tolerance during surgical consent

Purpose The legal interpretation of consent has transitioned over the last decade. Surgeons must identify what patients value to individualise surgical consent. This presents a considerable challenge during busy ward rounds or outpatient clinics. We aimed to develop and evaluate a novel risk tolerance tool to aid surgical consent. Methods This prospective, longitudinal cohort study evaluated the views of adult, elective surgical patients from a single centre. Attitudes to the existing surgical consent process were assessed (n = 48) and responses underwent thematic analysis. From these responses and a stakeholder focus group, a novel risk tolerance tool was developed. The risk tool was evaluated using questionnaires in 25 pre-operative patients. Post-operatively, the same cohort were followed-up with a telephone clinic 6–8 weeks after discharge. Results Overall patients were satisfied with the current consent process, but negative themes emerged including that it is generalised, impersonal, and time pressured. The developed risk tool contained six domains: death, pain, loss of physical function, loss of cognitive function, need for repeat medical interventions, and social disability. Loss of physical function (mean = 34.0, SD = 12.8) and loss of cognitive function (mean = 34.0, SD = 6.1) had lowest risk tolerance, and need for repeat medical interventions (mean = 18.8, SD = 10.9) had the highest risk tolerance. Thirteen (93%) patients had a positive experience of the consent process vs 85% of patients in pre-consent tool cohort. Conclusions The tool demonstrated good patient acceptability and patient reported experience. The tool gathered data that may enhance understanding of patient risk tolerance and personalise the surgical consent process.

Evaluation of the physical and psychosocial sequelae of ICU admission at 3, 6, and 12 months post-ICU discharge using a validated scoring system and a post-ICU discharge telephone clinic

Evaluation of the physical and psychosocial sequelae of ICU admission at 3, 6, and 12 months post-ICU discharge using a validated scoring system and a post-ICU discharge telephone clinic

How text messaging can improve the management of nurse-led clinics: a trial of direct messaging in a hyperthyroid telephone clinic

How text messaging can improve the management of nurse-led clinics: a trial of direct messaging in a hyperthyroid telephone clinic

Telephone clinic consultations in the post-COVID-19 pandemic era: an evaluation of factors affecting patients' level of satisfaction

Telephone clinic consultations in the post-COVID-19 pandemic era: an evaluation of factors affecting patients' level of satisfaction

CN24 Experience with the routine use of ePROMs in nurse and pharmacist-led telephone clinics for patients with prostate cancer

CN24 Experience with the routine use of ePROMs in nurse and pharmacist-led telephone clinics for patients with prostate cancer

Use of a remote assessment pathway for diagnosis of carpal tunnel syndrome.

We undertook a retrospective cohort study of a remote carpal tunnel syndrome assessment pathway created in response to limitations caused by the COVID-19 pandemic. Between July 2020 and September 2021, 702 patients referred from primary care (general practice) were assessed in a nurse-led telephone clinic using the carpal tunnel questionnaire of Kamath and Stothard (2003). Depending on their questionnaire score, patients were referred either for nerve conduction studies or a consultant hand surgeon review for diagnosis and treatment planning. Questionnaire scores of 3 and above accurately predicted a likely diagnosis of carpal tunnel syndrome in 83% of patients, and a diagnosis was unlikely in 90% of those with a score below 3. The pathway resulted in an estimated cost savings of £24,436 (€28,862, US$30,945) in comparison with the pre-pandemic service. However, some limitations in the pathway may have impacted effective patient management and we suggest possible improvements.Level of evidence: III.

Patient and carer perceptions of video, telephone and in-person clinics for Phenylketonuria (PKU)

BackgroundIn phenylketonuria (PKU), attending multidisciplinary clinic reviews is an important aspect of life-long care. Since the COVID-19 pandemic, video and telephone clinics are used as alternative methods for people with PKU to have contact with their care team. There is limited research concerning patient preference, experience and perceptions of alternative types of clinic review. Individuals from the UK with PKU and their caregivers were invited to complete an online questionnaire, hosted on the National Society for PKU (NSPKU) website and social media platform.ResultsData was available from 203 respondents. Forty one per cent of respondents (n = 49/119) preferred in-person clinics; 41% (n = 49) a hybrid of in-person, video and telephone clinics; 9% (n = 11) video clinics only, 6% (n = 7) telephone only and 3% (n = 3) were unsure. The main respondent obstacles to in-person clinics were costs, travel and time, but this was balanced by the benefits of a physical examination and better patient engagement/motivation. Twenty one per cent (n = 36/169) of respondents were uncomfortable with the number of healthcare professionals (HCPs) in a clinic room. Patients were less likely to consult with a doctor on video (64%, n = 91/143) or phone (50%, n = 59/119) reviews compared to in-person (80%, n = 146/183). Issues with video and telephone reviews included the shorter time length of review, distractions, technical issues and poor patient engagement.ConclusionsOnline video and telephone clinic platforms were effective in overcoming the challenging circumstances in management, monitoring and treatment of patients with PKU during the COVID-19 pandemic. However, in-person clinics remain the preferred respondent option. It is important that HCPs are flexible, enabling people with PKU a choice of clinic options according to their individual clinical need and circumstances.

Review article: Telecare in gastroenterology-Within the COVID-19 pandemic and beyond.

Telehealth is a growing model of care, greatly accelerated with the demands of the COVID-19 pandemic. Telecare is a synchronous audio-visual or audio-only format of health delivery. To evaluate the existing literature on telecare within adult gastroenterology subspecialties to determine if outcomes are comparable to traditional in-person consultations and to highlight the Pokapū Network, a local initiative in the Lakes Region of New Zealand, amongst these international findings. We completed an OVID MEDLINE search using the terms gastroenterology, endoscopy, digestive system, inflammatory bowel disease, functional, hepatology, liver, telemedicine, telehealth, videoconferencing, remote consultation, video clinic and telephone clinic. Patients showed positive attitudes towards telecare and, in several reports, would elect to have telecare consults in the future. Telecare reduces travel time and out-of-pocket costs for patients and the need for patients to take time off work. Generally, patients engaging with telecare show equivalent health outcomes to patients engaging with traditional models of care. Patients from ethnic minority groups or lower socio-economic backgrounds, or who are older, are less likely to complete a 'successful' telecare consult. Telecare is a useful model of care to allow gastroenterology centres to function within the context of COVID-19 isolation and beyond. It has significant benefits for patients who face geographical and financial barriers to accessing healthcare. Telecare models such as the Pokapū Network hold promise in reducing inequities for gastroenterology patients. Such models must be introduced with consideration of digital disparities that exist amongst patients to avoid worsening the digital divide.

Exploration of Preliminary Objective Triage by Menopause Score and CA 125 Result Prior to Accelerating Fast-Track Booking for Suspected Ovarian Cancer-A Role for the Pathway Navigator?

The 28-days-to-diagnosis pathway is the current expected standard of care for women with symptoms of ovarian cancer in the UK. However, the anticipated conversion rate of symptoms to cancer is only 3%, and use of the pathway is increasing. A rapid triage at the moment of receipt of the referral might allow resources to be allocated more appropriately. In secondary care, multidisciplinary teams (MDTs) use the risk of malignancy index (RMI) score, (multiply menopausal status pre = 1 or post = 3 × ultrasound score = 0 - 3 × the CA 125 level), using a score of >200, to triage urgency and management in possible ovarian cancer cases. The most powerful determinant of the RMI score variables is CA 125 level, an objective number. Could a simple modification of the RMI score retain a high sensitivity for cancer whilst improving specificity and, consequently, decrease the morbidity of false-positive classification? To test this hypothesis, a retrospective evaluation of an ovarian two-week-wait telephone clinic of one consultant gynaecological oncologist was undertaken. Enquiry re menopause status was scored as one for pre- and three for postmenopausal or uncertain. CA 125 levels of >67 u/mL for premenopausal and >23 u/mL for postmenopausal women were used to precipitate urgent cross-sectional imaging requests and MDT opinions. These CA 125 cut thresholds were calculated using an assumption that the RMI imaging score, regardless of whether the result was available, could be three. We contemplate that women who did not exceed a provisional RMI score of >200 might be informed they are extremely unlikely to have cancer, removed from the malignancy tracker and appropriate follow-up arranged. One hundred and forty consecutive cases were analysed; 43% were deemed premenopausal and 57% postmenopausal. Twenty of the women had cancer, eighteen (90%) of whom had an RMI > 200. One hundred and twenty were benign, and only twenty-three (19%) classified as urgent cases in need of accelerated referral to imaging. In contrast, CA 125 > 35 u/mL, whilst retaining the sensitivity of 90%, misclassified 36 (30%) of the benign cases. It is possible that a telephone triage via a questionnaire determining menopausal status and the CA 125 result could offer a sensitivity for cancer of 90% and urgent expert review of under 20% of benign cases. This rapid initial telephone assessment could be presented by a trained pathway navigator, physician associate or nurse specialist. Substantial savings in NHS cancer services resources, anxieties all around and reduced patient morbidity may occur as a result.

Perspectives of genetic counseling supervisors regarding genetic counseling students' attainment of practice-based competencies in clinical care through remote supervision.

There are limited studies regarding the attainment of the Accreditation Council for Genetic Counseling Practice-Based Competencies by genetic counseling students who complete clinical rotations in an in-person setting versus in a remote setting that incudes telephone and/or video patient encounters. This study explored the perceptions of 17 patient-facing genetic counselors who had served as supervisors for genetic counseling students regarding student attainment of practice-based competencies in in-person compared to remote rotations. Participants were recruited through an American Board of Genetic Counseling eblast and were required to have at least 2 years of clinical experience and experience providing genetic counseling supervision for at least one in-person rotation and one remote rotation. Four focus groups were created comprising genetic counselors from various practice disciplines. Discussion focused on potential differences and similarities in supervisor perceptions of student attainment of each clinical practice-based competency, and whether there were any concerns about students being able to attain each competency in remote rotations. Overall, participants discussed that genetic counseling students' attainment of clinical competencies through remote rotations was comparable to in-person rotations; however, 15 themes were identified illustrating differences reported by participants in how they observed these skills being performed by students in in-person versus remote clinical settings. The findings of this study highlight important considerations when developing a remote rotation, as well as ways in which certain clinical skills may be further enhanced through a combination of both in-person and remote clinical experiences. A noted limitation of remote rotations is that students have less of an opportunity to interact with other providers, and so may require other opportunities for interprofessionalism and to understand their role as part of a larger organization. Further study is required to elucidate differences between telephone and video clinics, as well as potential differences pertaining to various specialty areas of practice.

P24 Improving the patient pathway for timely referral and management of infantile haemangioma

Abstract Infantile haemangiomas (IH) are vascular tumours which typically present soon after birth and grow rapidly at a young age. Complications can arise depending on location and rapidity of growth of the lesion1. Timely treatment with an oral beta-blocker can limit growth and speed up resolution of IH. Not infrequently, we noted babies were being referred at a stage when most of the growth of the IH had already taken place. These patients often had skin breakdown, or a large haemangioma, making successful treatment harder to achieve. We aimed to educate GPs and health-visitors regarding the need for timely referral and to speed up the triage process for these patients. Information was sent to regional GP practices, with instructions on referral criteria according to the BSPAD guidelines for treatment of IH. A photograph of the IH was requested at the time of referral. Submitted referrals were triaged promptly and where appropriate, booked directly into a telephone clinic. After telephone consult, IH meeting the criteria for propranolol were booked directly for commencement of the beta-blocker with a paediatric review. If there was diagnostic doubt or other complications, a timely face to face review was arranged. Patients not requiring oral treatment were discharged back to GP. A patient satisfaction questionnaire revealed that parents appreciated the speed of assessment and reduced hospital visits. We describe an educational intervention and triage strategy resulting in improvement in the timing of referral and management of infantile haemangioma.

A Retrospective Audit of the Triage Process Introduced for Breast Referrals Received During the Covid-19 Pandemic

PurposeDue to restrictions on breast clinic appointments during the Covid-19 pandemic, a triage process was introduced for new patient referrals. The robustness of this process was examined by analysing the incidence of cancer diagnosis and wait times to treatment. MethodsPatients were triaged by secondary care consultant surgeons to an urgent appointment if they had high-risk symptoms based on prespecified guidelines eg, a lump or previous cancer. Those with non-urgent symptoms were seen on a deferred basis. A retrospective audit of patients referred between March 23 and July 20, 2020 was performed, to investigate incidence of cancer, concordance of primary and secondary care diagnosis, and the wait times to first appointment. ResultsMost patients with breast-related symptoms received a face-to-face appointment (69%) with a Primary Care Physician (PCP) or Nurse Practitioner (NP), with 544 (31%) having a telephone PCP/NP appointment. Of 2023 patients, 1461 were triaged by the receiving breast unit to an urgent appointment, 461 to a deferred appointment and 101 to a breast pain telephone clinic. A diagnosis of breast cancer was made in 111/1461 (7.6%), 5/461 (1.1%) and 0% in these triaged groups respectively, and the median wait time to first appointment was 14 days (range 1-94), 32 days (range 6-114) and 21 days (range 10-52, P < .001). ConclusionThe one-stop triage process was safe, with statistically fewer cancer diagnoses in patients allocated a deferred appointment, at a rate similar to that seen in a screening population.

Local nurse-led outpatient follow-up pathway to identify and meet the needs of ostomates: a service evaluation

Background: In the changing face of healthcare, the number of nurse-led clinics has increased. This is also the case for stoma clinics in the UK. Although there is no standardised pathway, ostomates (person living with a stoma) in the UK are routinely followed up either by telephone or face-to-face depending on the need to deliver timely patient care. High-quality care and experience are important determinants of patient satisfaction in healthcare and align with the government's long-term plan, which expects this as standard. Therefore, this study explored the views and needs of ostomates to better understand the experiences and wishes of ostomates that attend a nurse-led clinic at a local hospital. Background/Aims: The aim of this study was to evaluate ostomates’ experience of care delivered on the stoma care nurse-led outpatient follow-up pathway. Methods: An adapted data collection tool was used to evaluate face-to-face and telephone clinics in a 3-month period (December-February). A non-probability convenience sample of 246 patients who accessed the pathway face to face (n=122) or by telephone (n=124) were surveyed. The questionnaires were sent to consenting respondents who had either a colostomy ileostomy or urostomy. Results: A total of 117 questionnaires were returned, with a response rate of 48%. The results showed that 98% of respondents on the face-to-face pathway said the nurse had answered all their questions compared to 80% on the telephone. Nine out of 10 (90%) of respondents were very satisfied with the overall telephone consultation, while only 68% of respondents were very satisfied with the overall face-to-face consultation. Almost all (97%) of ostomates from the face-to-face clinic were happy with the length of their appointment, compared with 81% of those from the telephone clinic. Overall, the respondents are generally happy with the service offered to them and they valued the role of the stoma nurses. Conclusions: The service evaluation highlighted several good areas of practice and identified areas that need improvement, including offering preference of type of clinics to ostomates. Both options of face-to-face and telephone consultations could be presented to ostomates to ensure appropriate quality of care. In addition, an action plan has been put in place to improve identified needs.

Which pandemic working practices should be kept? Perspectives from staff working in a breast cancer service

Background/Aims Breast cancer is the most common female cancer in the UK, with approximately 60 000 new cases diagnosed each year. The service changes implemented in response to the COVID-19 pandemic altered ways of working and influenced care delivery. The aim of this study was to explore how these changes affected staff members' care practices and experiences, and how this has influenced subsequent changes to breast cancer services. Methods Purposive, snowball and opportunistic sampling was used to recruit 18 clinical and administrative staff members at the Nottingham Breast Institute. Data were collected from participants using semi-structured qualitative interviews, held either over the telephone or via Microsoft Teams. The interview transcripts were analysed and coded using thematic analysis. Results Interview responses covered adaptations to services in response to COVID-19, attitudes towards working during the pandemic and future recommendations. Participants highlighted the rapid response to the pandemic and the crucial role of information technology to support remote working. They also emphasised the role of partnerships with private hospitals to maintain surgical capacity. Participants supported the idea of maintaining some of the changes going forwards, such as telephone clinics, the increased flexibility of work, and help from the private sector. Conclusions Changes made to breast cancer services during the pandemic helped to create a more sustainable workforce. Services need to continue to implement change and target issues to create a more resilient NHS that is better equipped to deal with future challenges.

Examining the Effectiveness of Telephone Clinics: A Review of a Telephone Foot and Ankle Orthopaedic Clinic in a District General Hospital in the United Kingdom.

Since the outbreak of COVID-19, significant value has been placed on preventative methods for pathogen spread.One suchmethod is the use of telemedicine via telephone clinics (TC). This article is designedto study TCin a District General Hospital in the United Kingdom. This clinical audit aims to evaluate the use of a TC in the United Kingdom and assess its effectiveness. It also aims to assess the use of a clinician-led triaging system to select patients who would receive subsequent telephone follow-ups (TFU). Two cycles were conducted. The first cycle was conducted in 2020 and the second cycle in 2022. Inbetween the two cycles, a clinician-led triage system was implemented to reduce the number of patients being called back for a face-to-face (FTF) appointment. Data was collected regarding the outcomes of the appointments and compared between the two cycles. Chi-squared test statistical test was employed with a p-value < 0.05 deeming significance. Overall, more discharges were made for 2022 outcomes compared to 2020 outcomes (30% vs 19%; p = 0.03) after employing the clinician-led triage. The number of patients listed for a TFU increased when comparing the 2020 versus 2022 datasets (21% vs 12%; p = 0.026), and the overall number of patients not attending appointments decreased when comparing the 2020 versus 2022 datasets (9% vs 17%; p = 0.033). This articleshows that for this particular clinic, an orthopaedic clinician-led triaging system allows for a greater number of patients to be discharged, lessened need for FTF consultations, and increased adherence to appointments by patients. However, much work is yet to be done concerning the long-term consequences and issues of rolling out nationwide telemedicine.

HPB P60 Satisfaction Rates with Telephone Follow-Up Clinic Appointments

Abstract Background Since the onset of the COVID-19 pandemic, telephone follow-up (TFU) clinics have become an integral part of delivering healthcare. Advantages of telephone clinics include reducing costs and increasing efficiency. This quality improvement project (QIP) was conducted to evaluate patient satisfaction rates with hepato-pancreato-biliary (HPB) telephone follow-up clinic appointments and improve those rates. Methods The Likert-scale is a 13-item questionnaire tool ranging from 1-5 (1=strongly disagree, 5=strongly agree) and was used to assess patient satisfaction with TFUs, both before and after implementation of measures for improvement. Satisfactory cut-off point (score of 4) was analysed across all responses. Retrospective questionnaires were completed for 100 patients pre-interventions, and for 42 patients post-interventions. All patients were verbally consented. Presentation of initial findings and education surrounding areas to be improved at a departmental meeting, and use of a structured teleconsultation template were the measures implemented for improvements. Outcomes included overall satisfaction rates across gender and age groups. Results The overall satisfactory rate with TFUs improved from 75% to 95.2%. When analysed according to sex, the satisfactory rates improved for males from 67.6% to 91.7%, and for females from 79.4% to 96.7%. As for satisfactory rates according to age, improvements were noted in 3 out of the 4 pre-determined age groups; &amp;lt;50 years improved from 72.2% to 100%, 50-59 years declined from 88.9% to 80%, 60-69 years improved from 71.4% to 100% and &amp;gt;70 years improved from 72% to 93.7%. Conclusions Initial findings were positive but there was still room for improvement. The 2 main interventions used were discussion and teaching in a departmental meeting, and the implementation of a teleconsultation template. Implementation of these measures were successful in significantly improving the satisfactory rates with TFUs.

Comparison of percutaneous coronary intervention versus medication in dialysis patients with coronary artery disease

Abstract Background There is a lack of evidence for the optimal management of dialysis patients complicated with coronary artery disease (CAD). Based on the favorable results from patients with normal or near-normal kidney function, percutaneous coronary intervention (PCI) has extended to patients on maintenance dialysis. However, it is unknown whether this extrapolation is accurate. Purpose We sought to investigate the benefits of PCI in dialysis patients with CAD. Methods Between January 2015 and June 2021, 455 617 consecutive cardiac catheterizations from 30 cardiac centers in China were reviewed retrospectively through medical records. Patients with normal coronary anatomy, those who did not receive dialysis therapy or received dialysis for less than 3 months, those who received coronary artery bypass grafting, repeat admissions, and those with less than one year of follow-up were excluded. Patients were followed up via telephone interviews or clinic visits until June 2022. The primary outcome of interest was 1-year all-cause mortality, and the secondary outcome of interest was 1-year cardiac death. Cox proportional hazards regression model was used to assess the association of PCI with outcomes. Inverse probability of treatment weighting was used to control for imbalances in patient characteristics. Results Of 1 119 patients who met the final criteria, 799 (71.4%) received PCI. The mean age was 61.9±10.6 years, and 828 (74.0%) were male. Compared with medically treated patients, patients in the PCI group were more likely to present with a high Gensini score, be with multivessel diseases, and receive dual antiplatelet and statin therapy. Overall, 201 (16.4%) all-cause deaths were documented, with 153 (13.7%) cardiac deaths. Patients treated with PCI experienced significantly lower cumulative rates of 1-year all-cause deaths (15.5% vs. 24.1%, log-rank p&amp;lt;0.001) as well as cardiac deaths (11.5% vs. 19.1%, p&amp;lt;0.001). Multivariate analyses showed that PCI was independently associated with a lower risk of either all-cause deaths (hazard ratio 0.48, 95% confidence interval 0.36-0.64, p&amp;lt;0.001) or cardiac mortality (hazard ratio 0.45, 95% confidence interval 0.30-0.61, p&amp;lt;0.001). These findings were further confirmed in the inverse probability of treatment weighting cohort. Conclusion This cohort study found that in real-world practice, among dialysis with CAD, use of PCI was associated with significantly lower risks for 1-year all-cause death or cardiac mortality compared with medical management. Further prospective studies are needed to confirm these findings.

TITLE THE TEENAGE AND YOUNG ADULT (TYA) POPULATION (16-24YO) BENEfiT FROM HAVING SPECIALIST NURSE INPUT

Abstract AIMS The aim of this review is to analyse the need for a specialist nurse role for the TYA patients. Having a new dedicated TYA developmental role implemented can help by identifying areas for improvement from the wider team to ensure optimal support for patient group. METHOD Clinic attendance over a 1-year period has been measured. Looking specifically at patients who did not attend (DNA) appointments in a monthly TYA joint surgical and oncology clinic. We have evidence engaging this age group with the creation of a nurse led weekly telephone clinic for TYA patients and have looked at the trajectory of attendees throughout the year. RESULTS To date, nurse led clinic has had 107 individual bookings between August 2022 and February 2023. This is a devoted telephone clinic to provide holistic care. CONCLUSIONS There were 107 nurse lead telephone clinic appointments that were booked and attended by this patient group over 6-month period. This was protected time for which the nurse specialist was able to explore patients individual care needs in a holistic way. Figures for holistic needs assessment (eHNA) are yet to be collated; but the TYA group are now routinely offered eHNA to ensure a holistic care approach and support to this vulnerable patient group.

The continuation of oral anticoagulation and antiplatelet therapy for dento-alveolar surgery: a service evaluation.

Background Patients taking oral anticoagulants (OACs) and oral antiplatelets (OAPs) have a risk of post-operative bleeding when dental extractions are required. Guidance exists to assist dental practitioners on how best to clinically manage these patients, but this is based upon low-quality evidence. The current service evaluation provides real world clinical data when these drugs are not discontinued for oral surgery procedures.Materials and methods All OACs and OAPs were continued and patients requiring dental extractions had local haemostatic measures (local anaesthesia with adrenaline, socket packing with haemostat and resorbable sutures). All patients were offered a follow-up via a telephone clinic service after surgery to assess any post-operative bleeding.Results A total of 439 patients underwent 513 surgical episodes, equating to 1,001 dental extractions. Overall, 412 (95.9%) patients reported no post-operative bleeding complications. A total of 18 (4.1%) patients reported post-operative bleeding requiring further intervention. All but two patients were managed with local haemostatic measures, and no patient required hospital admission. For the single novel OAC cohort of patients, 8/185 (4.3%) procedures had post-operative bleeding.Conclusion This current service evaluation highlights that the risk of significant or life-threatening bleeding following dental extraction when OACs or OAPs are continued remains rare.