key: cord-0818147-c9enhwc9
authors: Horan, M.; Swan, E.; Daly, K.; McLornan, L.
title: Abstract 56 Implementation of telemedicine in response to COVID-19 in a Dublin hospital - A patient perspective
date: 2021-09-30
journal: European Urology Open Science
DOI: 10.1016/s2666-1683(21)00222-6
sha: 097c9b9f8653a6011858802da7bacdd6a90aae2b
doc_id: 818147
cord_uid: c9enhwc9

nan

Introduction: COVID-19 has changed how patients interact with the health service and how we deliver our service. We hypothesised that the initial phase of the pandemic would change how patients presented with acute ureteric colic, and how confirmed ureteric stones were managed. Methods: Retrospective analysis of patients presenting to North West Urology (4 acute hospitals) with acute ureteric colic between March 2020 and May 2020 compared with the same period in 2019. Data was collected using electronic records based on emergency non-contrast CT scans. Primary endpoints were rate of acute kidney injury (AKI) and emergency renal decompression by any method. Results: 174 patients presenting to emergency departments with ureteric stones were identified. No significant difference was seen in pick-up rate (31% in 2019, 33% in 2020). Female patients were twice as likely to have a confirmed ureteric stone in 2020 compared to 2019 (24.03% vs 12.12%; p = 0.015). A similar difference was not observed in males. In patients with ureteric stones, lockdown was associated with a higher rate of AKI when adjusted for age, sex, stone size, and position (OR 2.57; CI 1.04-6.32; p = 0.040). Lockdown was also associated with a higher rate of emergency renal decompression (OR 3.88; CI 1.03-14.61; p = 0.045) when adjusted for age and sex, but not when adjusted for stone size and position. Conclusions: In patients with ureteric stones, lockdown was associated with higher rates of AKI and emergency decompression. This was statistically significant and may reflect delayed presentation or system pressures leading to sub-optimal outpatient management. Introduction: Testicular torsion is a urological emergency which necessitates early recognition by the physician and urgent surgical intervention if testicular torsion is suspected. The estimated incidence of testicular torsion is 3.5 per 100,000. Published studies quote an orchidectomy rate as high as 42% for presentations of acute testicular torsion.

Method: We reviewed all cases of testicular torsion between 1st January 2010 to 31st December 2020. Patients were identified by reviewing the theatre database and cases where an intra-operative diagnosis of testicular torsion was confirmed were included. Patient demographics, symptoms at presentation, duration of symptoms and length of time to theatre were recorded. Patients were then grouped into 2 groups; one group in which the testes was salvaged and bilateral orchidopexy performed and the other group in which orchidectomy was performed.

Results: We identified a total of 42 cases. Of these 17 patients (40%) required orchidectomy. The median age of all patients was 22 years old (range 16-51 years old). The most common presenting symptom was testicular pain (n = 39). There was no significant difference in age at presentation, or presenting symptoms between the orchidectomy and orchidopexy group. In the orchidectomy group 12 out of 17 patients presented with symptoms lasting more than 24hrs. In the orchidopexy group only 4 patients had symptoms lasting more than 24hours (P < 0.05).

Conclusion: A delay in presentation of greater than 24 hours after the onset of symptoms has been demonstrated to be biggest risk factor for orchidectomy in the setting of testicular torsion. Introduction: The COVID-19 crisis prompted rapid and widespread implementation of telecommunication in the outpatient setting, with virtual clinics introduced to reduce potential viral transmission.

Since the advent of the COVID-19 pandemic, many studies have been conducted looking at the potential advantages of telemedicine, namely reduced wait-times and lower non-attendance rates 1 . The objective of this study was to evaluate patient satisfaction with virtual Urology outpatient appointments and to establish their potential utility going forward.

Methods: This was an observational, cross-sectional study. Data was collected retrospectively by telephone survey. Outpatient appointments during a five week period were categorized as physical attendance or telemedicine. A survey was created by modifying a validated patient experience questionnaire (PEQ) and creating questions specific to a COVID setting. Questions were scored on a 5-point Likert scale with some questions requiring true or false answers. Results: Overall, surveys were collected from 78 patients attending the Urology outpatient clinic. 81% of patients would be happy to continue attending a virtual Urology clinic for the duration of the COVID-19 pandemic with 71.79% happy to continue with telecommunication post COVID-19. 76.92% of patients believed virtual reviews provided an equal level of care compared with prior in-person outpatient appointments.

Conclusion: During the COVID-19 pandemic, virtual outpatient care was well received by our patients, with 81% of patients agreeable to virtual care going forward. This supports the growing role of telemedicine as an adjunct to traditional outpatient appointments in the care of Urology patients.

Virtual Visits and the Future of No-Shows