24 hours that changed our future way of working

Write up

Introduction

For the purpose of this project we chose to look at an area within our service that required development which was also current to the here and now. In light of the current COVID 19 pandemic and the impact it had on our service the decision to move away from the majority of face to face patient contact to telephone consultations was a change we had to make almost overnight. This accelerated the restructuring of our service developing a new way of working for the future.

Method

The impact of COVID 19 forced us to stop all face to face clinics immediately in March 2020. To prevent minimal disruption to patient care the team established the transition of these clinics to telephone consultations. We worked closely with the clinic coordinators to ensure the transition was executed in a timely manner as much as possible under extreme circumstances. We increased the duration of team meetings to maintain communication and support between colleagues. Home working became the new norm following the safe working guidelines set out by the trust and government. Access and training to new technology was obtained e.g. Attend Anywhere. A patient telephone questionnaire was performed in order to evaluate the change in service. It was to capture the thoughts of how patients expected their future care to be delivered in the future.

Results

To gauge patient’s thoughts on the new way of working, we conducted a patient questionnaire about 6 months after the start of the pandemic when all patient contact was via telephone. This showed that 100% of patients were satisfied with telephone consultations at the start of the pandemic, 80% were happy to continue telephone consultations into the future, the majority stated that as long as they were stable with their MS they found it a great deal easier than having to travel to the hospital, park and access the hospital building. 15% of patients would like the choice of face to face appointments and 5% preferred video calling as they felt they were able to access the technology necessary. However as a nursing team we were aware many of our clinical activities needs face to face consultations, for example bladder scans, newly diagnosed patient assessments and injection treatment starts. To try and identify where we were able to see patients in clinic we carried out a full review of our clinic activity, which did show that we needed to increase capacity of telephone clinics to balance the decrease in face to face patients able to be seen in clinic. We were also aware that we would not be able to see patients in all the locations we did pre-pandemic. Also bringing patients into clinic will cause additional concerns as fewer patients will be able to be seen due to having time to clean the clinic room and the restriction on the amount of patients that can be in the waiting room together, this will lead to overdue consultations increasing.

Conclusion

Covid-19 has completely changed the way we conduct our clinics and delivery our mode of care. There is doubt that the journey has been extremely difficult, but has also brought many positives along the way. The patient questionnaire showed that the majority of people were happy with telephone consultations, the long term challenge will be to be aware of when patients need to be seen in clinic and having the capacity to see them. Telephone consultations will continue to be the main mode of contact patients will experience in the foreseeable future. Our service was very efficient in the early days of the pandemic ensuring that there was limited disruption to clinic activity, no clinics at this time were cancelled and patients still continued to have vital contact with a MS nurse to reduce hospital admissions. Moving forward, we as a team are aware that patients do need to be seen in a clinic setting, and we have now started to re-instate face to face clinic consultations. The service is aware that the situation will continue to evolve and change and we will need to re-evaluate regularly.