Urgent Appointments Research Articles

Orthodontic urgencies and their management during COVID-19 pandemic-A web-based survey.

This investigation aimed to evaluate the most common orthodontic urgencies, their management, and changes in routine biosafety measures and the total income of the dental office in South India during the COVID-19 pandemic. A questionnaire was drafted using Google Forms with questions in four domains pertaining to orthodontic urgencies, biosafety measures, treatment duration, and income. After validation, this questionnairewas sent to 750 orthodontists via WhatsApp messenger (WhatsApp Inc, Menlo Park, Calif) over a period of 14 days.Descriptive statistics and comparisons were performed using independent t- and Chi-square tests. Majority of the orthodontists (62.3%) had closed their clinics only during the first lockdown. Many (63%) had scheduled urgent appointments along with routine limited patients per day. The most frequent urgencies were related to the breakage of brackets, archwires, molar tubes, bands, and temporary anchorage devices. Aligners were the least problematic. The treatment time was also prolonged. Telephonic advice and virtual assistance via WhatsApp messages/videos were found to be successful in the management of urgencies.Most orthodontists had strengthened their routine biosafety measures.The financial impact of this pandemic was considerable, with nearly 50% reduction in total income. Urgencies linked to preadjusted edgewise appliances, such as breakage of brackets and tubes, and archwire-related injuries were the most common. Prolongation of treatment time and negative financial impact were the other problems encountered during this pandemic. Drastic changes had occurred in routine biosafety measures, which prevented the spread of infection among orthodontists and patients.

Watch for tachycardia

BackgroundWearable devices capable of measuring health metrics are becoming increasingly prevalent. Most work has investigated the potential for these devices in the context of atrial fibrillation, our case highlights the potential of wearable devices across a wider range of arrhythmia.Case presentationA 51-year-old woman was referred to the cardiology clinic for an assessment of symptoms of intermittent exertional shortness of breath and palpitation. The patient was otherwise fit and well, took limited alcohol and no caffeine, and was a never smoker. There was no family history of heart disease. Physical examination in clinic was unremarkable, and a 12-lead electrocardiogram (ECG), seven-day ambulatory ECG, exercise stress ECG, and trans-thoracic echocardiogram were all normal. During a severe episode the patient recorded an ECG using an Apple Watch (Apple Inc, California, USA). This was forwarded to the patient’s cardiologist, who suspected a broad complex tachycardia and organised an urgent follow-up appointment. A further 72-h Holter ECG monitor showed frequent sustained periods of monomorphic ventricular tachycardia, confirming the watch findings. The patient was started on beta blocker therapy with a rapid improvement in symptoms.ConclusionsCurrent smartwatch technology can reliably identify irregular rhythms and can distinguish atrial fibrillation from sinus rhythm, with emerging evidence supporting detection of other cardiovascular diseases, including medical emergencies. There may also be a role for wearable devices in screening young populations for predictors of sudden cardiac death. At present device outputs require clinician interpretation, but in the future patients may present to primary or secondary care with a firm diagnosis of arrhythmia and may already be making wearable device guided behaviour changes.

Post-discharge follow-up attendance after pediatric dermatology consultation in the emergency department: A retrospective analysis.

The emergency department (ED) is a frequent source of care for pediatric patients with dermatologic conditions, possibly owing to limited access to routine and urgent outpatient dermatology appointments. The demographics, clinical characteristics, follow-up scheduling practices, and attendance rates of 50 pediatric and 142 adult patients evaluated by the dermatology consult service in the ED were reviewed. High rates of follow-up attendance were observed in the pediatric and adult populations, with the majority receiving an appointment within 2 weeks. The dermatology consult service may play an important role in facilitating post-discharge access to outpatient care.

Radical Reorientation of the US Health Care System Around Relationships: Rebalancing the Transactional Model

“Dr Serra’s last urgent appointment for today just filled, but Dr Breznik can see you at 1 pm.” Same-day service. All is good, right? No. The work of managing this patient more than doubled, the patient was needlessly inconvenienced, potentially unnecessary tests were ordered, and hazards were introduced into his care. This patient has a complex medical and surgical history which Dr Serra has managed over several years. When the patient is seen, Dr Breznik labors to get modestly up to speed, applies some temporizing measures, and schedules an appointment 3 days hence with Dr Serra, who currently is standing down the hall, between seeing other patients, documenting.

Optometry independent prescribing during COVID lockdown in Wales

IntroductionDuring the COVID‐19 lockdown, primary care optometry services in Wales moved to a hub model of provision. Three independent prescribing models were available in different areas: a commissioned Independent Prescribing Optometry Service (IPOS), independent prescribers that were not commissioned and no independent prescribers available. This allowed a unique opportunity for comparison.MethodOptometry practices completed an online survey for each patient episode. Analysis of the data gave insight into patient presentation to urgent eye services and the drugs prescribed by optometrists. Medicines prescribed, sold or given and onward referral were compared between areas with an IPOS service (n = 2), those with prescribers but no commissioned service (n = 2) and those with no prescribers (n = 2).ResultsData from 22,434 reported patient episodes from 81 optometry practices in six health boards between 14 April 2020 and 30 June 2020 were analysed. Urgent care accounted for 10,997 (49.02%) first appointments and 1777 (7.92%) follow‐ups. Most (18,006, 80.26%) patients self‐referred. The most common presenting symptom was ‘Eye pain/discomfort’ (4818, 43.81% of urgent attendances). Anterior segment pathology was the most reported finding at first (6078, 55.27%) and follow‐up (1316, 74.06%) urgent care appointments. Topical steroids (373, 25.99% of prescriptions) were the most prescribed medications. More medications were prescribed in areas with an IPOS service (1136, 79.16% of prescriptions) than areas with prescribers but no commissioned service. There were more follow‐up appointments in optometric practice and fewer urgent referrals to ophthalmology in IPOS areas.ConclusionUrgent care services were most utilised by patients with discomfort caused by anterior eye conditions. IPOS services enabled optometrists to manage conditions to resolution without referral and without reduction in medications sold or given. Commissioners should recognise the value in reducing burden in urgent ophthalmology and the need for follow‐up as part of a commissioned independent prescribing service.

Early Detection of Breast Cancer-Related Lymphedema in COVID-19 Pandemic.

Background: This study aimed at presenting a prospective surveillance model of care delivered at home for women qualified for surgery due to breast cancer under the epidemic-related restrictions. Methods and Results: Women (age ≥18 years, diagnosed with breast cancer, no clinical features of upper limbs lymphedema, and a volume difference between the limbs <5%, not using any prophylactic compression products) will be provided with comprehensive education in the field of self-measurements and lymphedema prevention. The outcome measures include limb volume (circumferential measurements with a tape at 4 cm intervals), simplified protocol of three measurement points combined with the symptoms monitoring (according to the physical section of Lymphedema Quality of Life Inventory [LyQLI]). We propose a new calculation method as the RACI (relative arm circumference increase) in accordance with previous research-RAVI (relative arm volume increase) and the new proposal-the RACD (relative arm circumference difference). According to cylinder formula it can be calculated that 5% increase in limb volume results in ∼2% change in RACI. Regular appointments will be planned at 3, 6, 9, and 12 months after the enrollment. Additional urgent appointments will be arranged after the home or phone "red flags" (an increase circumference by ≥2%, positive pitting test, and any new symptoms) detection. We hypothesize that performing only three measurements combined with the typical symptoms monitoring would be accurate for lymphedema diagnosis based on the RAVI of ≥5%. Moreover, RACI/RACD increments combined with positive symptoms would correlate with RAVI. Conclusions: The new proposal of protocol can be the optimal solution in COVID-19 pandemic.

Exploring the views of patients' and their family about patient-initiated follow-up in head and neck cancer: A mixed methods study.

The objective of this work was to explore head and neck cancer (HNC) patients' and their family members' views on acceptability and feasibility of patient-initiated follow-up (PIFU), including concerns and anticipated benefits. Patients were recruited from UK HNC clinics, support groups and advocacy groups. They completed a survey (n= 144) and/or qualitative interview (n= 30), three with a family member. Qualitative data were analysed thematically, quantitative data using descriptive statistics. Preference for follow-up care in HNC was complex and individual. Many patients thought PIFU could beneficially reallocate health care resources and encourage self-management. Patients' main concerns with PIFU were losing the reassurance of regular clinic appointments and addressing mental well-being needs within PIFU, possibly using peer support. Patients were concerned about their ability to detect recurrence due to lack of expertise and information. They emphasised the importance of a reliable, direct and easy urgent appointment service and of feeling supported and heard by clinicians. Patients believed family and friends need support. PIFU may be feasible and acceptable for certain HNC patients, providing it addresses support for mental well-being, provides quick, reliable and direct clinician access and information on "red flag" symptoms, and ensures patients and their caregivers feel supported.

Patient Acceptance of Nurse Practitioners and Physician Assistants in Rheumatology Care.

To assess whether patients with autoimmune disease would accept advanced practice providers (APPs) as an option to fill the growing shortage of rheumatologists. We administered a cross-sectional survey to 500 patients or parents of children who reported having been diagnosed with qualifying autoimmune conditions and who had seen their primary rheumatology providers in the past 6 months. Respondents self-reported whether their primary providers were rheumatologists or APPs. Our analysis compared the attitude and experience of the patients whose primary rheumatology providers were APPs with those of patients whose primary providers were rheumatologists. Of respondents, 36.8% reported having APPs as primary rheumatology providers. Patients of APPs were significantly more likely to arrive at their provider's office in 15 minutes or less (P < 0.01) and to be able to schedule routine and urgent appointments sooner (P=0.02 and 0.05, respectively). There were no significant differences in overall patient experience of care between provider types. Most patients rated their providers highly, but those who saw rheumatologists rated their providers significantly higher (P < 0.01). Patients of APPs were significantly more likely than patients of rheumatologists to prefer to see APPs over rheumatologists (P < 0.01) and to recommend APPs (P < 0.01). APPs may improve access to care and, regardless of provider type, patients rated their overall experience of care similarly. Overall, patient attitudes toward APPs were positive regardless of provider type, although APP patients held more positive overall attitudes toward APPs than did rheumatologist patients.

Travel-Related Diseases and Injuries in Children and Adolescents: A Post-Travel Surveillance Questionnaire Assessment.

Children and adolescents are a relevant and increasing proportion of travelers. Injuries and infectious diseases in children are safety concerns when traveling. However, data on diseases and injuries during international travels in children are not available. The aims of this study were to analyze travel-related diseases and injuries among pediatric travelers during and after international trips, to identify risk factors for travel-associated disease, and to evaluate the compliance and effectiveness of the recommendations provided in pre-travel appointments. We enrolled travelers aged under 18 years attending a pre-travel clinic, in a tertiary hospital (2017 - 2019); 223 of the 370 pediatric travelers attending the pre-travel clinic were included. The study was based on a questionnaire designed to address health and safety issues - vaccines and chemoprophylaxis, including side effects, the occurrence of disease or injury, diagnosis, treatment, and outcomes. The median age at pre-travel evaluation was eight years; 39.7% of the travelers were adolescents, 52.5% were female. The participants traveled to 40 countries across four continents, with a median travel duration of 14.5 days. Asia was the most visited continent. Traveling was safe for 84.8%. From 34 travelers who had illness/injury, gastrointestinal symptoms were elicited in 41.2%. Sixteen (47.1%) travelers required an urgent medical appointment at the destination, and no one was hospitalized. Destinations in Africa and longer trips were significantly associated with a higher occurrence of disease/injury (p = 0.023 and p < 0.001, respectively). In a multivariable model, traveling to Africa was still significantly associated with travel-related disease/injury [OR = 2.736 (1.037 - 7.234)]. Disease/injury occurred in 15.2% of pediatric travelers. Even though 47.1% of the travelers required an urgent medical appointment, the developed conditions were not severe enough to warrant hospitalization. Travels to Africa and longer trips seem to be associated with a higher risk of disease and injury.

Potemkin Protections: Assessing Provider Directory Accuracy and Timely Access for Four Specialties in California.

The accuracy of provider directories and whether consumers can schedule timely appointments are crucial determinants of health access and outcomes. We evaluated accuracy and timely access data obtained from the California Department of Managed Health Care, consisting of responses to large, random, representative surveys of primary care providers, cardiologists, endocrinologists, and gastroenterologists for 2018 and 2019 for all managed care plans in California. Surveys were able to verify provider directory entries for the four specialties for 59% to 76% of listings or 78% to 88% of providers reached. We found that consumers were able to schedule urgent care appointments for 28% to 54% of listings or 44% to 72% of accurately listed providers. For general care appointments, the percentages ranged from 35% to 64% of listed providers or 51% to 87% of accurately listed providers. Differences across markets related to accuracy were generally small. Medi-Cal plans outperformed other markets with regard to timely access. Primary care consistently outperformed all other specialties. Timely access rates were higher for general appointments than for urgent care appointments. Our finding raise questions about the regulatory regime as well as consumer access and health outcomes.

Directory Accuracy and Timely Access in Maryland's Medicaid Managed Care Program.

We assessed provider directory accuracy and timely access in Maryland's Medicaid managed care program, using annual surveys from the annual random and representative provider surveys conducted on behalf of the Maryland Department of Health for 2018 and 2019. Based on 3,262 calls to 2,002 providers in 2018 and 2,739 calls to 2,033 providers in 2019, we found that provider directories are highly inaccurate. Insurance coverage could only be verified for 46% of the listed providers in 2018 and 56% of the listed providers in 2019. Among providers whose insurance participation was verified, beneficiaries were able to schedule timely general care appointments in 90% of verified providers in 2018 and 85% of verified providers in 2019; slightly more than 70% of appointments were scheduled on the first call. The success rate for urgent care appointments was lower but improved substantially once alternative providers were accounted for. Even for verified providers, timely access standards were often not met, particularly for general care. We also note the substantial variation across managed care organizations and across years. Our findings raise concerns from both an enrollee as well as a broader policy perspective. More oversight and enforcement are necessary to guarantee access to care.

Evaluation of Interventions Targeting Follow-up Appointment Scheduling After Emergency Department Referral to Ophthalmology Clinics Using A3 Problem Solving

Many patients seen for eye-related issues in the emergency department do not receive recommended follow-up care. Prior evidence supports that scheduling appointments is a barrier to accomplishing the transition to outpatient ophthalmology care. To evaluate time until appointment scheduling following emergency department discharge with urgent outpatient ophthalmology referral. The A3 problem solving process was implemented by a multidisciplinary team as part of a structured quality improvement program with the goal of reducing the mean time between urgent referral placement in the emergency department and outpatient ophthalmology appointment scheduling. The study was conducted at Stanford Health Care, an academic medical center in Palo Alto, California, affiliated with Stanford University School of Medicine. Using medical center administrative records, all patients discharged from the adult emergency department with an urgent outpatient referral to the Stanford Department of Ophthalmology from August 9 to September 19, 2020 (baseline; n = 43), and from October 26 to November 29, 2020 (after implementation of all interventions; n = 21), were included. Interventions developed to target the workflow of the ophthalmology resident, emergency department, ophthalmology clinic, and health system schedulers to address key drivers of the referral-scheduling process included medical record documentation guidelines, identification of responsible parties, preidentified appointment slots, patient education materials, and education of stakeholders, and were implemented by October 25, 2020. Mean time between urgent referral placement (ie, emergency department discharge) and appointment scheduling with outpatient ophthalmology at baseline vs postintervention. At baseline, appointments were scheduled a mean (range) 2.8 (0-7) days after referral placement. In the 5 weeks following implementation of interventions, the mean (range) decreased to 1.3 (0-4) days, a difference of 1.5 days (95% CI, 0.20-2.74; P = .02). This corresponds to 642 (95% CI, 86-1173) days of reduced patient wait time annually. In addition, there was less variability in the number of days between referral and appointment scheduling after intervention compared with baseline. The results suggest improvement in efficiency of outpatient ophthalmology appointment scheduling of urgent emergency department referrals could be achieved through application of a quality improvement methodology by a multidisciplinary team representing key stakeholders in the process.

CPNP 2022 Annual Meeting Poster Abstracts

CPNP 2022 Annual Meeting Poster Abstracts

Improving access to care via psychiatric clinical pharmacist practitioner collaborative management of buprenorphine for opioid use disorder

BackgroundAs the death toll continues to rise in the opioid overdose epidemic, increasing access to medications for opioid use disorder (OUD), such as buprenorphine, is vital. Psychiatric clinical pharmacist practitioners (CPPs) can help bridge the gap in care but are limited in their ability to prescribe buprenorphine given federal restrictions. ObjectiveThis study aimed to describe a pharmacist-psychiatrist collaborative practice designed to increase access to buprenorphine for OUD in rural communities by maximizing the CPP role. Practice descriptionA CPP operating under a scope of practice with prescriptive authority to manage substance use disorders (SUDs) and comorbid mental health conditions was hired in June of 2020 at a rural Veterans Affairs (VA) hospital in Tomah, Wisconsin. Practice innovationA collaborative agreement with X-waivered psychiatrists was established to manage buprenorphine for patients with OUD. Evaluation methodsA retrospective chart review was conducted on all patients with an OUD diagnosis from July 1, 2020, to October 31, 2021, to assess the use of medications for OUD, comorbid psychiatric, and SUD diagnoses; active naloxone prescription; and CPP involvement in care. For patients prescribed buprenorphine, their average wait time to initiation appointment was calculated in days and compared before and after CPP implementation. ResultsAs of October 31, 2021, there were 60 patients with OUD cared for by the Tomah VA, of whom 28 received buprenorphine comanaged with the CPP. On average, those requesting urgent access appointment for buprenorphine assessment from the CPP were seen for same-day induction appointments compared with historically an average of a 6.1 day wait for outpatient appointments and 5.8 days for scheduled inpatient inductions. ConclusionCollaborative approaches to buprenorphine management with a CPP improve access to care. Although collaboration decreases time burden for X-waivered psychiatrists, care could be more efficient and timely if a CPP could independently induct, stabilize, and manage patients on buprenorphine.

California Joins Six States in Setting Standards for MH/SUD Appointment Wait Times

California Joins Six States in Setting Standards for MH/SUD Appointment Wait Times

Feasibility of a Brief Intervention to Increase Rapid Primary Care Follow-Up Among African American Patients With Uncontrolled Diabetes.

The management of diabetes, like many other chronic conditions, depends on effective primary care engagement. Patients with diabetes without a usual source of care have a higher risk of uncontrolled disease, hospitalizations, and early death. Our objective was to study the effect of a brief intervention to help patients in medically underserved areas obtain rapid primary care follow-up appointments following hospitalization. We performed a pilot pragmatic randomized controlled trial of adult patients with uncontrolled diabetes who had been admitted to one of three hospitals in the Memphis, TN, area. The enhanced usual care arm received a list of primary care clinics, whereas the intervention group had an appointment made for them preceding their index discharge. Patients in both groups were evaluated for primary care appointment attendance within seven and fourteen days of index discharge. In addition, we examined barriers patients encounter to receiving rapid primary care follow-up using a secret shopper approach to assess wait times when calling primary care offices. Twelve patients were enrolled with six in each trial arm. Baseline demographics, access to medical care, and health literacy were similar across the groups. Primary care follow-up was also similar across the groups; no improvements in follow-up rates were seen in the group receiving assistance with making appointments. Identified barriers to making primary care follow-up appointments included inability to schedule an urgent appointment, long hold times when calling doctor’s offices and lack of transportation. Additionally, hold times when calling primary care offices were found to be excessively long in the medically underserved areas studied. The study demonstrates the feasibility of providing patient assistance with scheduling rapid primary care follow-up appointments at the time of discharge and the potential to improve care transitions and access to primary care among patients living in medically underserved areas. Larger pragmatic trials are needed to further test alternative approaches for insuring rapid primary care follow-up in vulnerable patients with ambulatory care-sensitive chronic conditions.

Is the shift to urgent appointments in general practice what patients really want?

Is the shift to urgent appointments in general practice what patients really want?

Why patients attend emergency department for primary care type problems: views of healthcare providers working in a remote community.

Emergency department (ED) utilisation continues to increase, particularly for primary care presentations that do not require high level ED services. The reasons for this are complex, and research has focused on patient perspectives in choosing where to seek care rather than those of ED and general practitioner (GP) providers. This study aimed to address this gap by exploring the views of ED and GP providers regarding ED utilisation for primary care type health conditions in a small, remote Australian city with perhaps unique population demographics and service configuration. Service providers from the ED and general practice clinics were invited to participate in focus groups and semi-structured interviews exploring their views on ED utilisation for primary-care-type health presentations. The data were analysed using thematic content analysis. In total, 24 healthcare providers (five GPs, seven ED practitioners, seven community nurse navigators, four Aboriginal and Torres Strait Islander Health Workers and one Indigenous Liaison Officer) participated in focus groups discussion and interviews. The analysis identified three themes: access and logistic barriers, rational decision-making and self-perceived urgency. While there was some overlap in the healthcare providers' perceptions, there were also strong differences between ED and GP groups. In particular, the ED group believed that GP services are less accessible for urgent appointments, whereas GPs believed that such arrangements were in place. Both groups agreed on the need for clear communication between the ED and general practice. ED and GP providers demonstrate similarities and differences in understanding patients' reasons for choosing which service to access. The differences may stem from ED providers' focus on offering a rapid resolution of acute presentations and GP providers' focus on offering comprehensive and continuing care. Effective communication between general practice and the ED services and clearer referral pathways may help in reducing ED utilisation for less urgent primary-care-type problems.

The Impact of the COVID-19 Pandemic on Israeli Orthodontic Practice: A Clinic’s Activity and Patients’ Attitudes

The current study aimed to characterize the activity in orthodontic clinics during the COVID-19-induced lockdown and the inter-lockdown periods, as well as to evaluate patients’ perspectives with respect to their fears, their extent of cooperation with treatment, and their emergency needs during the lockdown. The data were gathered from 11 private orthodontic clinics from 1 January 2020 to 8 March 2021, which included three lockdowns and inter-lockdowns. Information specifying the number of admissions, missed appointments, and emergency visits was gathered. Four hundred and twenty-nine orthodontic patients treated in those clinics agreed to complete a questionnaire that evaluated their concerns and expectations, the treatment emergency issues, implementation of the orthodontist’s instructions, and contact with the clinical staff during lockdowns. There was a significant increase in the number of scheduled appointments during the inter-lockdown periods, compared with the pre-pandemic period (p = 0.001). No difference in the number of missed/canceled or emergency appointments was found between the different periods (p > 0.420). The majority (89.6%) of the emergency visits involved issues with appliances; 68.7% of the subjects were advised to present themselves at clinics. During the peaks of the waves of the COVID-19 pandemic, a sharp rise in the number of missed and urgent appointments was not found. Reducing the number of orthodontic emergencies may assist in reducing patient fears.

EVALUATING THE IMPACT OF THE COVID-19 PANDEMIC ON URGENT MEDICAL ACCESS FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE AT A PRIVATE COMMUNITY GASTROENTEROLOGY PRACTICE

BACKGROUNDPatients with inflammatory bowel disease (IBD) are subject to frequent emergency department (ED) visits. In order to decrease unnecessary ED utilization, we established an urgent care hotline (IBD URGENT) at a private community gastroenterology practice to triage pressing concerns from our patients with IBD. However, at the beginning of the Coronavirus disease 2019 (COVID-19) pandemic in Mar 2020, in-person visits were converted to telehealth visits, which could have adversly impacted patient care. Therefore, we examined the impact of the COVID-19 pandemic on the access and utilization of urgent healthcare by patients with IBD.METHODSIn Jun 2018 we implemented a triage system involving gastroenterologists, nurses, and support staff to enable patients to contact our practice for urgent IBD issues with the goal of providing a plan of action from a provider within 4 hours of the call. Incoming patient calls were flagged with a red exclamation mark and labeled as “IBD URGENT” in our electronic medical record (eClinicalWorks) if they met any of the following criteria: new, severe abdominal pain; new, severe anal pain; fever greater than 101F; refractory emesis; or anything otherwise deemed urgent by the clinic nurses. Patients were then either advised to present to the ED for immediate evaluation, scheduled for same-day/next-day medical appointment +/- urgent labs, or received medical advice such as medication changes. The number (two-sample t-test) and triage (two-sample Z-test) of IBD URGENT calls were compared between pre-COVID (Jun 2018-Feb 2020) and post-COVID (Mar 2020-Sep 2021).RESULTSA total of 366 IBD URGENT calls were received and 91% had a response from a provider within 4 hours (Figure 1). The average number of IBD URGENT calls received per month were comparable pre- and post-COVID (10 vs 9, p=0.32). From Mar 2020 onwards, 40% of IBD URGENT calls were managed by urgent appointments, 51% medical advice, and only 9% ED visits, which was comparable to pre-COVID (Table 1).Figure 1. Graph illustrating breakdown of monthly IBD URGENT calls, and percentages of response within 4-hr of callTable 1. Average number of IBD URGENT calls per month and percentages of triage results comparing pre-COVID and post-COVIDCONCLUSIONIt is reassuring that the COVID-19 pandemic did not cause any significant changes to the utilization and triage outcomes of the urgent IBD hotline system in our practice. Timely clinical operational changes to meet the needs of patients with the onset of the pandemic has allowed our proportion of ED visits to remain comparable to pre-COVID despite the decrease in in-person visits. As we return to normal operations, we plan to sustain our urgent hotline service by educating new staff and by reminding our patients of the IBD URGENT service. We believe this service improves quality of care for patients with IBD by avoiding unnecessary ED visits that often include overuse of Computer Tomography (CT) scans and prescription of steroids and narcotics—all associated with significant risks and financial costs.