Lessons Learned from a Vitreoretinal Virtual Service in a Tertiary Referral Center.

Abstract

Background: We present our experience in telemedicine in a tertiary referral hospital covering the west of Scotland, from November 29, 2021, to June 27, 2022. We piloted vitreoretinal virtual clinics where patients were directly referred by community optometrists or by general ophthalmologists. Most patients were referred with an accompanying Optical Coherence Tomography (OCT) scan. A consultant vitreoretinal surgeon reviewed the scans with any accompanying-colored pictures and conducted a telephone consultation with the patients. This study aimed to analyze the efficacy of this virtual service to improve delivery of future care. Methods: This was a retrospective audit study. All patients booked into the virtual telephone clinics for one consultant were identified through the electronic referral pathway and health care records. The total number of patients booked into these virtual clinics was 284, of which 258 attended. Each patient's referral letter and clinic letter were reviewed. Patients were also sent a questionnaire to assess their experience accessing the virtual clinic. Results: Of the 258 patients who attended the virtual clinic, 55 patients were listed for surgical intervention, 6 were sent for outpatient treatment, 38 were invited for a face-to-face consultation, 10 were offered surgery but declined, and 149 were discharged from the clinic. Our patient questionnaire found that 86% of attendees were satisfied with the accessibility of the appointment and 63% were confident in the quality of care provided. Conclusions: The combination of patients requiring no further treatment and those declining treatment demonstrated a 62% reduction in the number of face-to-face hospital appointments required. We believe the use of imaging such as OCT and wide-field colored fundus photography proves to be an excellent tool for assessment of patients in combination with a telephone discussion of symptomatology and management plans. This approach can also prove cost-effective for both the health care systems and the patients.