The ongoing peaks and troughs of the COVID-19 pandemic have imposed unprecedented challenges on day-to-day healthcare provision that we all took as given across the globe prior to spring 2020! The pandemic has, in many ways, made us push boundaries and rapidly devise innovative ways of continuing to provide healthcare whilst trying to avoid incurring additional risks on to patients and healthcare professionals. This paper looks at analysing the successes and challenges of audiovisual outpatient consultations for new referrals. It shows that, as with many things in life, there may not be one solution that fits all scenarios, but the pandemic has opened many new avenues that may be utilised to help improve healthcare provision if delivered in the appropriate situation. We thank all our reviewers and team for all the hard work and contributions.
Nazia Munir and Hannah Cooper
During the COVID-19 pandemic, the interest in tele-consultations was revitalised, as they offered the benefit of reduced exposure and risk of infection. In the present paper, the authors undertook a systematic review, following the PRISMA guidelines, assessing the outcomes in terms of patient pathway efficiency, patient and clinician satisfaction, cost analyses and safety implications. A total of 53 studies were reviewed, representing a mix of follow-up patients and initial presentations to the service. For the former group, tele-consultations were adequate in most cases for the assessment of the patients, reducing time-to-referral and cost, while offering increased patient satisfaction rates. The rate of transforming the consultation to a face-to-face appointment was very variable, being reported as 1.5 to 45% for follow up-patients and 13 to 72% for those that were first referred to the service. The authors conclude that these findings are suggestive of a need to select the patient groups being offered a tele-consultation, and further noting that the quality of clinical images that were available to clinicians along with clinical information were pivotal for diagnostic accuracy. This is the first systematic review synthesising data on tele-consultations in literature, being an ambitious attempt to draw some conclusions of our experience so far. One limitations of noticeable concern is the nature of tele-consultation, as telephone and video communication may significantly impact the diagnostic process. As expected, and reported by the authors, there is a variation in the rate of conversion of the tele-consultation into a face-to-face review, the highest being in the head and neck clinics. Unfortunately, there are not enough studies to allow for a meaningful individual analysis of the conversion rate of each clinic category and there is no data about laryngology, otology and paediatric ENT clinics. Lastly, it is important to mention that the analysed studies were undertaken in multiple different countries, rendering the implications in cost reduction hard to assess due to the differences of healthcare systems and accessibility of patients to equipment and technology.