A systematic review of outcomes of remote consultation in ENT

Abstract

Aims Remote or tele‐consultation has become an emerging modality of consultation in many specialities, including ENT. Advantages include increasing accessibility, potential to reduce costs and, during the COVID‐19 pandemic, reduced risk of infection transmission. Here, we systematically collate and synthesise the evidence base on outcomes from remote consultation in adult and paediatric ENT services. Methods We performed a review in accordance with PRISMA guidelines. We searched Medline and Embase for relevant articles. Outcomes include specific patient pathway efficiency measures (including number of healthcare visits, lead time, touch time and handoff), patient/clinician satisfaction, cost analysis and safety implications. Results From 6325 articles screened, 53 met inclusion criteria. Publications included studies on remote consultation for initial, preoperative and follow‐up assessment (including postoperative). In most instances, remote consultation reduced costs and time from referral to assessment and was associated with high patient satisfaction. However, a face‐to‐face follow‐up appointment was required in 13%‐72% of initial consultations, suggesting that remote consultation is only appropriate in selected cases. Conclusion Remote consultation is appropriate and preferable for ENT consultation in specific conditions and circumstances. Future research should look to better define those conditions and circumstances, and report using recognised quality standards and outcome measures.

Patient and clinician experiences of remote consultation during the SARS-CoV-2 pandemic: A service evaluation

“…Aside from practical challenges, the literature supports our participants’ feelings that it is the nature of the consultation that makes it appropriate for remote appointments or otherwise. 33 , 34 For diagnosis, physical examination, difficult conversations and bad news and consultations with the vulnerable, the findings of our evaluation reflect the other empirical work to date that remote consultation is not fit for purpose in these contexts 30 , 35 – 38 but could be an adjunct to usual care. 38 …”

Introduction of a novel telescopic pathway to streamline 2‐week‐wait suspected head and neck cancer referrals and improve efficiency: A prospective service evaluation

“…Evidence already exists to suggest that remote assessment using telemedicine may be a feasible option in ENT. [8][9][10][11] Indeed, a visual examination of the upper aerodigestive tract, usually in the form of flexible nasendoscopy and oral examination with a headlight, is essential for the assessment of suspected HNC patients. Both the acquisition of high-quality images and the development of technology, which allows secure storage and forwarding of such images facilitates an environment in which senior clinicians can provided a comprehensive clinical assessment entirely remotely.…”

A rapid review of the effectiveness of remote consultations versus face-to-face consultations in secondary care surgical outpatient settings

“…Previous reviews (Petersen et al 2021, Gupta et al 2021, Kolcun et al 2020, Fahey et al 2021, McMaster et al 2021, Chaudhry et al 2021) and a review of systematic reviews (Smith et al 2021) have explored the usage, effectiveness or cost-effectiveness of telemedicine across a variety of surgical specialities prior to the COVID-19 pandemic. These have demonstrated the feasibility of the use of telemedicine for perioperative and/or postoperative care for adults and paediatric undergoing a variety of surgical procedures and overall, patients are satisfied with telemedicine in surgical practice.…”