Written by Blythe Wilkinson, our all-round compliance Queen
Clinicians around the UK are feeling the COVID-19 pressure. Remote consultations between clinic-based staff and patients should help to reduce the spread of infection, keep staff safe and hopefully well. But as we are all starting to experience, remote-working is not as simple as sitting on your sofa with a cuppa and a laptop. No Sireeee.
It's pretty important to have a good remote-working strategy, particularly to support those clinicians self-isolating, or who have caring responsibilities. Wearing noise-cancelling headphones does not drown out the sound of restless teenagers (that tip was just a bonus).
Now we're obviously also writing this because we think we have a neat solution (hint hint check out our little Nye Phone), but we have a lot more general advice we wanted to share that will hopefully be useful for any clinician doing remote consultations.
Just as a little reminder, telephone and video consultations are appropriate for:
Triaging and assessing patients with symptoms suggestive of coronavirus and
Consulting with patients who have other problems, unrelated to the virus, but who would ideally not attend the surgery
A few broader points - You gotta plan ahead
Having plans in place well in advance will allow everyone to be prepared for remote-working in case this has to implemented at short notice
Many clinicians already have access set up to patients electronic medical records from home via a VPN. Clinicians who do not have this facility should be set up now, to enable home working when needed
Sort Nye Phone accounts (obviously other providers are technically available 😉) for all your clinicians - so they’re ready to work anywhere, on any device
Having a trial run of using remote consultations from home before you really need it is a good idea. That way you can check that you have the correct software, bandwidth etc
Consider how to keep in touch with your team- either to provide advice to more junior members of staff, to compare notes on how you’re approaching patient care remotely, or simply to offer moral support. This will be a stressful time. Invite your home-working staff to join any clinical meetings on-line, or set up completely on-line meetings. Drop-in virtual coffees can be great too.
Ensure your colleagues know that you’re working from home, and have re-structured the practice appointments system accordingly
Inform your reception team or triage clinicians that you’re consulting remotely, and that you should not be booked face to face appointments
Provision must be made for those patients who (after triage) require onsite face-to-face assessment
Consultations should only occur with patients where the clinician has access to the patient’s electronic medical record, other than in exceptional circumstances
Access to the EMR must only be set up via a VPN
Ensure that your home device has appropriate anti-virus software installed and that it’s switched on
For home consulting, you will need to use Nye via your mobile phone, because you'll be logged into a practice desktop via the VPN. This is handy though, as your phone already has its own microphone and speakers. Make sure you have set your permissions to allow your internet browser on your mobile to access these in 'Settings'.
Most GPs and many Practice Nurses/ Nurse Practitioners will have experience of telephone triage which will be vital during a pandemic.
Having the option to switch a proportion of calls to video increases the possibility of completing assessment remotely without the need for a face-to-face appointment.
While most clinicians may be very familiar with triage as a way to defer non-urgent work, not all will have experience of using remote consultation as the primary option, aiming to complete all consultations as far as possible. Team support will be vital at this time, so remember to compare notes on how you’re approaching this. Consider on-line team coffee hangouts.
As COVID-19 could be with us for many months (like that friend from school who was never really your friend), it would be inadvisable to default to deferring full patient assessment: this could result in patients suffering adverse consequences as a result of delayed care, or a backlog of unmanageable unmet need when we emerge from the immediate crisis
For non-COVID problems: It will ultimately be your professional opinion whether or not a patient should be brought into the practice for physical examination. This will depend on whether examination is likely to change your management. For instance, if you know that a patient requires admission based on a video consult, regardless of whether you then see them face to face, try speaking to the acute admissions team in secondary care and justify your reasons for requesting direct admission.
If you choose not to see a patient face to face, carefully safety net with the patient and document your reasoning
There are also tonnes of general tips on managing remote consultations now available in the British Journal of General Practice
That's just some of our unsolicited advice.
You're welcome 😘