LAUSR

The use of virtual consultations in health care is gaining support. In a study of some long-term conditions, the Department of Health in England concluded that telehealth and telecare offer significant benefits for service delivery and patient satisfaction.1 Greenhalgh et al (2016) suggested that virtual online consultations may be more cost-effective for both patients and the healthcare system.2 Shaw et al (2018) concluded that, when clinically appropriate, video consultations were effective, safe and convenient.3 The Haemophilia Comprehensive Care Centre at Belfast City Hospital provides care for people with bleeding disorders across Northern Ireland, some of whom live up to 104 miles from the Centre. Challenges to service delivery for scheduled and unscheduled multidisciplinary reviews at the Centre include the time taken for each review, the distance travelled and attendance rates of service users. The aim of this initiative was to provide alternative ways of supporting patients with inherited bleeding disorders of all severities by developing a multidisciplinary approach to clinic review using a virtual platform. Progressing the concept of virtual consultations introduced in 2015 with the development of nurse-led telephone review clinics for patients with mild Haemophilia. In January 2020, a meeting was arranged with the Trust Information Technology (IT) Department to consider the feasibility of using virtual consultations. Staff attended training in the use of Microsoft Teams, and an application was made to establish the ‘Haemophilia Team’ on the Microsoft Teams platform (licence and necessary permissions having previously been secured by Belfast Health & Social Care Trust). A proof-of-concept study was planned. A ‘time-in-motion’ study was carried out at the next available Haemophilia clinic (6th March 2020) to establish the usual patient journey at face-to-face multidisciplinary clinics. Fourteen of 22 scheduled patients attended (64%). This was comparable to an audit of 6 face-to-face clinics between March and August 2019 where the mean attendance rate was 69%. Of those patients attending all were seen by the nurse, 13 were seen by the Haematologist, 8 patients were seen by the social worker, 6 were seen by the physiotherapist and 2 were seen by the Occupational therapist. Mean time taken per consultation was 1 h 11 min (range of 21 min–2 h 19 min). A test clinic was subsequently carried out in preparation for going ‘live’, affording staff the opportunity to identify any issues with the process. However, prior to a planned virtual clinic pilot, COVID-19 restrictions were put in place, challenging the ability to hold regular faceto-face appointments. In this environment, the ability to hold virtual consultations offered the opportunity to maintain ongoing provision of multidisciplinary appointments for patients. A pilot multidisciplinary clinic involving Consultant Haematologist, Haemophilia Sister, Physiotherapist and Social Worker was planned and involved: