Developing a virtual geriatric perioperative medicine clinic: a mixed methods healthcare improvement study

Abstract

Background the Geriatric Perioperative Care clinic at North Bristol NHS Trust was suspended in March 2020 during the COVID-19 pandemic. A virtual clinic was piloted to deliver preoperative health optimisation and shared decision-making for patients undergoing critical elective surgery. No literature existed on virtual preoperative clinics for older people to support the development. Objective this healthcare improvement study describes the setup and delivery of the virtual clinic as its primary aim. Secondary aims included: assessing older people’s access to technology and their digital literacy for virtual consultation; to describe barriers and facilitators for consultations, as well as evaluation of patient and clinician satisfaction with the consultations' mode of delivery and outcomes. Methods a mixed methods healthcare improvement study was undertaken through plan-do-study-act cycles, semi-structure interviews, and quantitative service benchmarking. Results the pilot evaluated 67 preoperative consultations (43.3% video, 56.7% telephone, mean age 75) with a mix of surgical pathology (vascular 88.1%, colorectal 10.4%, urological 1.5%). Patient feedback demonstrated improved understanding of conditions (90.6%), and adequate opportunity to express opinions and questions (96.2%). Clinicians preferred video consultations (adequate to deliver services: 89.7% video; 68.4% telephone). The greatest barriers to engagement, none of which were exclusions to participation, included cognitive impairment, sensory impairment, or needing technical assistance setting up video consultations (52.2%). Conclusions delivering a virtual preoperative medical optimisation and shared decision clinic for older people is feasible. This study will aid other units in developing their own virtual preoperative clinics. Future work should evaluate perioperative outcomes of delivering a face-to-face versus virtual clinic.

Validation of the Self-Reported Domains of the Edmonton Frail Scale in Patients 65 Years of Age and Older

“…Joughin et al recently described implementation of their virtual geriatric perioperative medicine clinic. [31] Comprehensive geriatric assessments were converted to questionnaires which could be utilized during a virtual visit. Patient survey results following implementation demonstrated optimisms over the virtual methodology and particularly in the area of shared decision making.…”

“…Patient survey results following implementation demonstrated optimisms over the virtual methodology and particularly in the area of shared decision making. [31] Hands et al found that alternative management plans that occurred because of telemedicine proved to be advantageous for both patient and consultants. [32] Similarly, our study highlights that srEFS may be used across a variety of surgical procedures given the diversity of surgical procedures studied.…”

A protocol for a multicentre observational study across an integrated care system to understand the effect of living with frailty on access to video consultations

“…Patient involvement -In development of the pilot work 67 service user's feedback from a telephone survey has been published (13). -The department of medicine for older people service user group was consulted -Conversations occurred with ten patients from the user group having used the geriatric medicine clinic…”

“…- In development of the pilot work 67 service user’s feedback from a telephone survey has been published (13).…”

VIGIL - Video In Geriatric Intervention Clinic: A randomised controlled feasibility trial protocol comparing face-to-face and video delivery of a specialist preoperative clinic for older people

“…Video clinics can reduce the risk of hospital-acquired infection such as COVID-19, reduce travel with its associated financial and physical burden for patients as well as environmental impact, are delivered at times convenient for patients and doctors, and allow better access to special services for people across the UK. 7 Funding and Support in Kind…”