The COVID-19 pandemic has challenged our outpatients' service because our capacity to offer face to face (F2F) clinic visits was reduced. Therefore, early in the pandemic we initiated a virtual phone consultation (VPC) program. VPC allowed us to safely streamline access to F2F hospital contact for those patients who needed it during the pandemic while efficiently dealing with our backlog of patients with less urgent clinical situations. We were able to reduce our outpatient waiting list from over 1000 patients at the beginning of the pandemic to just 150 patients in early 2022. We plan to continue our use of VPC after the pandemic and therefore attention to quality improvement was necessary to ensure that effective and high-quality care is maintained. Consequently, we decided to evaluate patients' and clinicians' perspectives on VPC and identify areas for improvement.

A telephone questionnaire for patients was designed that included closed questions on the concept of VPC, satisfaction with VPC, and on the practicalities of delivering VPC. There was an open question on suggestions for improvement. Two researchers delivered this telephone survey to a random sample of 100 patients selected from our VPC clinics that took place between December 2021 and February 2022. The patient telephone survey was done either on the same day as the VPC or up to three days after. We also designed a survey for clinicians. This survey involved questions on the concept of VPC, clinician satisfaction, and practical aspects of organising effective VPC clinics. We included an open question that aimed to determine which categories of patients clinicians thought were best suited to VPC and an open question on potential dangers that VPC may carry. Finally, we included an open question on clinicians' suggestions for improvements to our VPC program. Regarding closed questions, our results were presented as proportions and mean scores from 5-point Likert scales with standard deviation (SD). We analysed the themes that were identified in answers to open questions.

56 men and 44 women were included in our patient survey (average age of 69 years). Most patients agreed with the idea of doing VPC and the average satisfaction score for patients' most recent VPC was 4.42/5 (SD 0.90). Patients appreciated the benefits of VPC and the top three perceived benefits of VPC from the patients' perspectives were lower infection risk (69 patients), lack of need to travel (36 patients) and increased efficiency (7 patients). 67 patients said that the phone call was made on time. 1 patient reported a late telephone review. 22 patients were unaware that F2F reviews could be done instead of VPC at their request. 58 patients said that they would like a F2F review for their next appointment. 2 patients suggested that being given a written summary of the VPC would be beneficial and 2 suggested using video calls. 11 clinicians (6/9 consultants and 5/7 registrars) participated in the clinician questionnaire. The majority were satisfied with the use of VPC and wished to continue the use of VPC. 6 clinicians stated that they tended to call the patients earlier than the scheduled time and 1 clinician tended to call patients late. Clinicians felt that the benefits of VPC were increased efficiency (8 clinicians), lower infection risk (6 clinicians) and reduced cost (5 clinicians). Clinicians felt that patients with normal scan results (10 clinicians) and patients unable to travel (10 clinicians) were most suitable for VPC. The perceived disadvantages of VPC were the inability to do physical examination (9 clinicians), inability to draw diagrams to form a better understanding (7 clinicians), and poor rapport due to lack of person-to-person interaction (7 clinicians). 7 clinicians felt that the lack of physical examination might delay diagnoses and treatments. To improve the service, 3 clinicians felt that giving patients a written summary of the VPC would be beneficial.

We found that patients and staff are satisfied with our VPC program and understand its advantages. We think that our service can be improved by ensuring patients know that F2F reviews can be requested at their discretion. It was helpful to know that our patients do not want video calls and that F2F reviews are preferred by patients after an initial VPC review.