Background: The Covid-19 pandemic has led to a need for alternative methods of doctor-patient communication. Most healthcare providers have utilised telecommunication to minimise face-to-face contact whilst continuing to provide essential services. At our institution, patients are being triaged by consultant breast surgeons to clinic or phone/video consultation on the basis of the referral letter. This triage system has gradually changed as the pandemic situation stabilised, with more emphasis placed on patient risk factors. This study aims to demonstrate the accuracy of this process as it improves at a single tertiary hospital.
Materials and Methods: Data was collected prospectively from March 17th to June 30th 2020. All breast patient referrals, having been triaged to either one-stop clinic, phone consultation or video consultation at Derriford Hospital, United Kingdom, were analysed. Electronic records were examined for clinic outcomes and histopathology results.
Results: 871 referrals were received and analysed. 588 (67.5%) of referrals were triaged to phone consultation; 270 (31%) were triaged to one-stop clinic; 12 (1.4%) were triaged to video consultation; and 1 (0.1%) was reviewed as an inpatient. 60 (6.8%) cancers were confirmed on histopathology. In March, 6 out of 8 cancers were triaged to clinic initially (75% sensitivity) with 44 out of 80 benign cases being triaged to phone consultation (55% specificity). 6 out of 42 patients with clinic appointments were diagnosed with cancer (14.3% positive predictive value [PPV]) and 44 out of 46 of phone consultations were benign (95.7% negative predictive value [NPV]). In June, 17 out of 22 cancers were triaged to clinic (77.3% sensitivity) and 230 out of 309 benign cases were triaged to phone or video consultation (74.4% specificity). PPV was 17.7% and NPV 97.9%.
Conclusions: This study demonstrates improvement in the accuracy of the triage system as the process evolved. Despite switching to alternative forms of communication, there is ongoing and timely diagnosis of breast cancer from referrals. As such, given the long term implications of Covid-19 and the subsequent desire to keep hospital foot-fall as low as feasible, telephone and video consultation will continue to be utilised. Further analysis of the cost-effectiveness of this process will need to be performed however to ensure resources are allocated appropriately.
ESSO20V-0051