Audit of early use of virtual clinics during the COVID-19 pandemic at a district general hospital and its implications for future practice

The COVID-19 pandemic has changed how healthcare is delivered, with an emphasis on using technology to minimize hospital visits In the dermatology department of a district general hospital, we describe our early experience of replacing faceto-face consultations with video or telephone consultations in response to COVID-19, including facilities for patients to email photographs Alongside this major change, our patient cohort presents additional challenges with a high incidence of skin cancer, and an elderly population who may be less confident using technology (http://www ncin org uk/skin/laua/at las html) Data were collected over 43 days during May-July 2020 for nonsurgical appointments Two hundred and eightyfour appointments were recorded Average age was 55 5 years (range 0-97) Nineteen (6 7%) appointments did not go ahead;18 did not answer and one was a prisoner for whom necessary preparations were not arranged Of these, 13 were rebooked, five were discharged and one was booked for surgery based on photos Of the appointments that proceeded, 210 (79 2%) used telephone only, 37 (14 0%) used video only, 15 (5 7%) used a combination and three (1 1%) were face to face Reasons cited for not using video included 55 (25 8%) instances telephone deemed sufficient, 50 (23 5%) patients not ready on video software at appointment time, 38 (17 8%) not internet savvy, eight (3 8%) had not received the instruction letter, six (2 8%) had technical issues, three (1 4%) requested telephone consultation and two (0 9%) requested a face-to-face instruction In the remaining 51 (23 9%), no reason was documented For patients aged ≥ 65 years, 18 of 127 appointments (14 2%) proceeded by video vs 27 of 155 (17 4%) in those aged ≤ 65 years Ninety-seven (36 6%) patients emailed photos beforehand and 48 (18 1%) were asked to provide photos afterwards One hundred and nineteen (44 9%) virtual consultations avoided hospital visits;43 patients were discharged and 76 had routine follow-up arranged The data shows that, despite initial difficulty implementing, virtual clinics provide significant potential for reducing hospital visits Elderly patients were less likely to achieve successful video calls and may benefit from focused support It was noted anecdotally that patients receiving preparatory phone calls from administrative staff to explain the software had a higher uptake of video consultations Going forwards, we plan to reaudit, evaluating the impact of administrative staff routinely contacting patients prior to appointments In the long term, although virtual consultations cannot completely replace face-to-face consultations, this may become an increasingly utilized option reflecting patient choice