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Telemedicine for postoperative consultations following vitrectomy for retinal detachment repair during the COVID-19 crisis: a patient satisfaction survey

Published:December 07, 2020DOI:https://doi.org/10.1016/j.jcjo.2020.11.011
      The most recent World Health Organization (WHO) report on the coronavirus disease 2019 (COVID-19) pandemic confirms a total of 4 013 728 cases, with a death toll of 278 993.

      World Health Organisation. Coronavirus disease (COVID-19) pandemic. 2020. www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed 11 May 2020.

      The staggering number of deaths has thrust us into embracing telemedicine within ophthalmology, with the increased use of video and telephone consultations, to reduce the risk of virus transmission.
      • Williams AM
      • Kalra G
      • Commiskey PW
      • et al.
      Ophthalmology practice during the coronavirus disease 2019 pandemic: the university of Pittsburgh experience in promoting clinic safety and embracing video visits.
      At our tertiary eye unit, we continue to provide a 7-day-a-week emergency retinal surgical service; however, our postoperative review has been modified to include telephone consultations, rather than face-to-face patient contact. As part of an ongoing plan to transform the vitreoretinal emergency service, we conducted a survey of patient perspective on the use of telephone consultations to replace routine postoperative review as a possible long-term plan.
      We conducted a retrospective patient satisfaction survey of 53 consecutive patients who presented with a retinal detachment over a 6-week period since the beginning of the lockdown in United Kingdom on 23rd March 2020. All patients received a postoperative telephone consultation 2 weeks after their emergency vitrectomy for retinal detachment repair. We asked detailed questions on pain, redness, visual improvement, approximate size of gas bubble, new shadows, and worsening vision and confirmed their drop regime. Those patients who were thought to have any symptoms of raised intraocular pressure (IOP) or redetachment were asked to attend the vitreoretinal emergency (VRE) department for a face-to-face assessment. Patients with a long-acting gas bubble were booked in for a further phone call at 6 weeks after the date of the surgery. Asymptomatic patients were discharged with retinal detachment warning. The survey had a total of 10 questions, including a free text box for patient comments that were not addressed within the closed survey questionnaire. The survey was conducted by an independent member of the administration staff at the hospital to obtain an unbiased response.
      The results of the survey are summarized in Figures 1 1C. Overall, of the 53 patients, 26 were male (49%) and 27 were female (51%). The patients scored the overall satisfaction with the phone consultation at a mean of 4.3 out of 5. The satisfaction score for the clarity of the phone call was 4.9 out of 5. 51 patients (96%) felt that the clinician was able to answer any management questions over the telephone. Forty-eight patients (91%) felt that they received the appropriate advice regarding the postoperative drop regime, whereas 9% felt that this subject was not broached at the time of the phone consultation. Overall, 34 patients (64%) felt that a telephone consultation postoperatively was a sustainable replacement to face-to-face review, whereas 19 patients (36%) felt that this was not an appropriate platform to replace face-to-face consultations, after the COVID-19 pandemic. After the telephone consultation, 3 patients (6%) patients were asked to return to VRE for a further assessment to rule out a redetachment, of whom 2 patients (4%) had a redetachment and underwent a further emergency procedure. One patient (1%) presented to eye casualty department with a new shadow before the telephone consultation and was found to have a redetachment. In addition, 2 patients (4%) were seen in casualty with pain in their eye before their consultation and were found to have a raised IOP and were treated accordingly. After the phone consultation, a further 3 patients presented to the VRE unit with a redetachment over the next 6 months since their surgery. There were no reports of other postsurgical complications such as endophthalmitis, vitreous haemorrhage, optic capture, or optic neuropathy.
      Fig 1
      Fig. 1(A) Patient feedback questionnaire. (B) Survey questions with a 1–5 rating scale. (C) Pie chart to represent number of patients who answered yes or no to questions relating to telephone consultation.
      Fig 1
      Fig. 1(A) Patient feedback questionnaire. (B) Survey questions with a 1–5 rating scale. (C) Pie chart to represent number of patients who answered yes or no to questions relating to telephone consultation.
      Patient satisfaction surveys are an essential source of information for identifying gaps in clinical care and planning quality improvement within health care organizations.
      • Al-Abri R
      • Al-Balushi A
      Patient satisfaction survey as a tool towards quality improvement.
      Our patient survey revealed that two-thirds of patients were willing to consider replacing face-to-face consultations with a telephone consultation, even after the pandemic. However, owing to the risk of missing patients with asymptomatic raised IOP, perhaps, a single visit at 2 weeks followed by a telephone consultation for those with a long-acting gas may be a suitable compromise. We did not report any other surgical complications after the initial telephone consultation, and although the patients were not reviewed face to face, given that our unit is one of the main eye units providing 24-hour emergency eye care within the greater London area, we would expect patients who developed any visual complications after their procedure to attend our hospital and be reviewed within the vitreoretinal unit. Notwithstanding the COVID-19 pandemic, the growing capacity issues within ophthalmic practice means that telemedicine platforms will become a key tool in delivering this care to a wider population in the future.
      • Ting DS
      • Gunasekeran DV
      • Wickham L
      • Wong TY.
      Next generation telemedicine platforms to screen and triage.

      Footnotes and Disclosure

      The authors have no proprietary or commercial interest in any materials discussed in this article.
      Acknowledgements: Hilary Newman, medical secretary, for conducting the telephone surveys.

      References

      1. World Health Organisation. Coronavirus disease (COVID-19) pandemic. 2020. www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed 11 May 2020.

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        • et al.
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