Enhancing patient experiences with remote/virtual consultations (RC/VCs) for a sustainable standard practice model: A Quality Improvement Project.
Authors: Syed Obaid , Anosova Anna , Kelleher Kyle , Dancyger Caroline , Hales Elaine , Suttie Neil , Byrne Bernie , Gajapathy Venkatash , Anand Girija , Khan Khurum H. 
Published: June 2022

e18620

Background: The COVID-19 pandemic and its recurrent waves of infection have propelled the transformation of many outpatient clinics into RC/VCs on an international scale. The Oncology Service at NMUH, based in the UK’s NHS, conducted a survey in June 2021 to explore patient experiences of these RCs and aimed to implement changes to refine the service. Methods: Patients were recruited from breast, gastrointestinal and lung oncology clinics between April and June 2021 for the first ‘plan-do-study-act’ (PDSA) cycle and in November 2021 for the second PDSA cycle, to participate in an anonymous telephone survey by an independent researcher, 48-72 hours following their consultations. Three broad areas of satisfaction including practical aspects of communication, patient autonomy and control during the consultation, and patients’ emotional experiences were evaluated, yielding both quantitative and qualitative accounts to be compared as a measure of success. Following the first cycle, a new cover letter was devised to be sent alongside the outpatient appointment letter entitled ‘How to get the most out of your remote consultation’. The second PDSA cycle was then undertaken to assess the success of the intervention. Results: A total of 51 patients were recruited in the initial survey and 15 patients in the second. Quantitative analysis demonstrated comparable levels of satisfaction in both cohorts across all domains. 46/51 (90%) of patients felt their remote oncology consultations were overall ‘Excellent’, ‘Very Good’ or ‘Good’ in the first group compared with 13/15 (86%) in the second group. 86% of patients ‘Strongly agreed’ that all their questions and concerns had been addressed compared with 58% of patients prior to our intervention. Qualitative data, in the form of patient quotes, highlighted the success of the intervention, addressing patient concerns that were previously raised, namely communication challenges, not having relatives present, the lack of patient preparation ahead of the consultations, managing expectations relating the timing of the appointment and the lack of key points of contact post-consult. Positive aspects of RC/VCs included feeling safer, more flexibility, reduced need for travel and waiting in hospital. Furthermore, we introduced the option to choose between a conference call, video call or face-to-face consult instead of a phone call to personalize experience and maximize patient choice. Conclusions: This study was practice changing. Our data demonstrates that the introduction of the accompanying cover letter successfully enhanced patient experiences and satisfaction with their RCs. Overall, selective RCs should be considered as standard practice in the future. This will enable reduced cancer waiting times, unnecessary exposure of vulnerable patients and improved patient experience by minimizing hospital visits.