Delivering outpatient appointments through video consultations
Ashford and St. Peter’s Hospitals NHS Foundation Trust
What was the problem?
In 2018/19, Ashford and St. Peter’s Hospitals (ASPH) hosted approximately 10,000 face-to-face outpatient appointments per week, with a 7% increase in appointments expected each year.
As part of its strategy to help fulfill the NHS Long Term Plan commitment to reducing physical face-to-face appointments, ASPH adopted video to deliver some outpatient consultations. The aim was to:
- minimise physical attendances, protecting patients, staff and the community, particularly during the Coronavirus (COVID-19) pandemic
- reduce the cost of attending hospital appointments for patients and their carers/families, including the cost of travel, car parking, childcare and time off work
- improve patient satisfaction and convenience
- increase remote working for clinicians.
- reduce carbon emissions from travelling to appointments.
What was the solution?
ASPH were part of the NHS England and NHS Improvement national video consultation pilot which provided access to Attend Anywhere, a video consultation platform. The platform was initially used with musculoskeletal (MSK) therapies in October 2019 with its use rapidly scaled up in March/April 2020 with the onset of the COVID-19 pandemic.
Video consultations enable patients to remain at home or at work for their consultation.
They also facilitate remote working for clinicians. This allowed clinicians who needed to self-isolate or to shield as a result of COVID-19, to safely continue with their patients’ appointments, avoiding the need to cancel these appointments.
ASPH adapted their established procedures for booking patients into video consultations where clinically appropriate within their Patient Administration System (PAS). The trust also ensured they sent patients relevant information leaflets to help them use the platform, along with their appointment letter and text reminders.
To upscale the use of video at pace, the trust created and recorded live training sessions for clinicians and administrators supported by crib sheets. Over 350 members of staff attended these training sessions within three weeks.
What were the results?
The use of video consultations at the trust increased rapidly when the nationwide lockdown to reduce the spread of the coronavirus was implemented.
At the beginning of March, the trust conducted around five video consultations per week. This increased substantially to over 300 per week following the announcement of the lockdown measures. This figure continues to rise.
By the end April 2020, there were 38 different waiting/clinic areas on the video consultation platform, servicing 25 specialities and between mid-March and end of April 2020, the trust conducted 1145 video consultations with patients. These figures also continue to rise.
The initial MSK therapies pilot completed an evaluation of patient views relating to their video consultation. Of the 82 patients seen during the pilot:
- 92% did not require a face to face follow up or were discharged. This is above the comparison for First Contact Physiotherapy where the benchmark sits at 60%.
- 81% would have travelled to their face to face appointment by car; this saved 135kg of CO2 emissions – the equivalent of a single person flying from London to Barcelona.
66% of staff reported enjoying working from home and 72% of MSK therapists reported no increase in emotional intensity whilst conducting remote clinics.
What were the challenges?
- Training – the rapid upscaling of video consultations required rapid training for clinicians and administrators. Eleven live stream training sessions were delivered over a 7-day period for clinical and administrative staff. This allowed over 350 staff members to be trained remotely and safely. Recordings of the livestreams are now available to staff at any time via the trust’s intranet.
- Support to specialty teams – the rapid rollout of virtual clinics had the potential to cause confusion and workload pressures for local teams. Weekly meetings for service managers and clinical office teams, along with senior manager and senior clinical support, provided forums for staff to ask questions and determine new common practices across specialties, along with development of a new Standard Operating Procedure (SOP) for video consultation.
- Technological support – the trust’s Information Technology team and clinical ‘super-user’ put in many hours of work to meet the technological demands for remote working and for sufficient hardware devices to be set up and rolled out quickly.
- Patient Information – as well as patient information leaflets, a patient video was recorded and uploaded to the trust’s website detailing how to access and use the platform. It can be found here.
- Data/activity reporting – activity for video consultations is recorded in the trust’s PAS which requires a one-week time lag to enable administration teams to populate the system in full before accurate reporting can be made.
- Working with all specialties to identify further clinics and patient cohorts for whom video consultation could be a safe and appropriate delivery method now and in the future.
- Maintaining the high proportion of ‘virtual’ outpatient consultations (delivered either by telephone or video) beyond the COVID-19 challenge.
- More robust evaluation of patients and clinicians experience to inform future support and pathway developments of video consultations.
- Review of the pathway for triage and patient choice of appointment bookings for new referrals with our primary care partners.
- Learning from other sites to identify new and other innovative ways to use video consultations within the trust.
Want to know more
Please contact Jamie Parkinson, Clinical Specialist MSK Physiotherapist and Attend Anywhere Clinical Lead, Ashford and St. Peter’s Hospitals NHS Foundation Trust, at Jamie.firstname.lastname@example.org.