Use of Teleconsultations in a Regional Stereotactic Radiosurgery Service: Pilot Study.

BACKGROUND: The National Health Service Long Term Plan details plans to make digital interactions available to all patients in 5 years. Teleconsultations can improve access to specialist services; however, there is a lack of evidence for the use of teleconsultations in an oncology setting in the United Kingdom. OBJECTIVE: We aim to describe a service evaluation of teleconsultations for patients attending a regional brain metastases clinic. These patients have unique travel restrictions that prevent them from driving. METHODS: From April to October 2018, all patients attending the brain metastases clinic were offered the choice of teleconsultation in place of a face-to-face appointment. Feedback was assessed using a satisfaction questionnaire, and data of all clinic attendances were collected. RESULTS: A total of 69 individual patients had 119 appointments over the duration of the pilot, of which 36 (30.2%) were new patient appointments and 73 (61.3%) were follow-ups. Of the 69 patients, 24 (35%) took part in teleconsultations (41/119, 34.5%). User satisfaction was high, and no patients who took part in a teleconsultation reverted to face-to-face appointments. These patients avoided 2521 miles (61.6 miles per appointment) of hospital-associated travel and travel costs of £441.48 (US $599.83) to £10.78 (US $14.65) per appointment. CONCLUSIONS: Teleconsultations appear to be acceptable in this cohort of patients with brain metastases attending a regional stereotactic radiosurgery service with the potential for significant savings in travel and expenses.

Short and Long term predictions of Hospital emergency department attendances.

OBJECTIVE: Emergency departments in the United Kingdom (UK) experience significant difficulties in achieving the 95% NHS access standard due to unforeseen variations in patient flow. In order to maximize efficiency and minimize clinical risk, better forecasting of patient demand is necessary. The objective is therefore to create a tool that accurately predicts attendance at emergency departments to support optimal planning of human and physical resources. METHODS: Historical attendance data between Jan-2011 - December-2015 from four hospitals were used as a training set to develop and validate a forecasting model. To handle weekday variations, the data was first segmented into each weekday time series and a separate model for each weekday was performed. Seasonality testing was performed, followed by Box-Cox transformations. A modified heuristics based on a fuzzy time series model was then developed and compared with autoregressive integrated moving average and neural networks models using Harvey, Leybourne and Newbold (HLN) test. The time series models were tested in four emergency department sites to assess forecasting accuracy using the root mean square error and mean absolute percentage error. The models were tested for (i) short term prediction (four weeks ahead), using weekday time series; and (ii) long term predictions (four months ahead) using monthly time series. RESULTS: Data analysis revealed that presentations to emergency department and subsequent admissions to hospital were not a purely random process and therefore could be predicted with acceptable accuracy. Prediction accuracy improved as the forecast time intervals became wider (from daily to monthly). For each weekday time series modelling using fuzzy time series, for forecasting daily admissions, the mean absolute percentage error ranged from 2.63% to 4.72% while for monthly time series mean absolute percentage error varied from 2.01%-2.81%. For weekday time series, the mean absolute percentage error for autoregressive integrated moving average and neural network forecasting models ranged from 6.25% to 7.47% and 6.04%-7.42% respectively. The proposed fuzzy time series model proved to have statistically significant performance using Harvey, Leybourne and Newbold (HLN) test. This was explained by variations in attendances in different sites and weekdays. CONCLUSIONS: This paper described a heuristic-based fuzzy logic model for predicting emergency department attendances which could help resource allocation and reduce pressure on busy hospitals. Valid and reproducible prediction tools could be generated from these hospital data. The methodology had an acceptable accuracy over a relatively short time period, and could be used to assist better bed management, staffing and elective surgery scheduling. When compared to other prediction models usually applied for emergency department attendances prediction, the proposed heuristic model had better accuracy.

Issues associated with dog bite injuries in children and adolescents assessed at the emergency department.

OBJECTIVES: The aim of this study was to determine the pattern of dog bites seen at the emergency department of a university hospital. The information will be used to plan prevention and enhance management strategies. METHODS: All patients (younger than 22 years) assessed at the emergency department between January 2003 and December 2004 with a discharge diagnosis of animal bites were identified through the computerized discharge network. RESULTS: One hundred forty-four incidents of animal bites (82 males and 62 females) occurred over the 2-year period. Eighty-nine percent was due to dog bites. Among the dog bite victims, the mean age was 11.82 years (SD, 6.39 years; range, 0.06-21.83 years). Family dogs were only involved in 15% of cases. The species of dogs were not recognized in three fifths, and attacks provoked in two fifths of victims. Most bites (90%) of bites involved only single anatomical sites. The extremities were commonly involved (right upper limb [23%], left upper limb [16%], right lower limb [35%], left lower limb [20%]). Torso (4%) and genitalia (0.8%) were uncommonly involved. Pain, erythema, bleeding, and bruising were common symptoms, but 60 patients were asymptomatic at presentation. Compared with older patients, children younger than 10 years had a much higher risk of facial injuries (25% vs. 2%, P = 0.0002; odds ratio, 21.8, 95% confidence interval, 2.9-455.9) and were more likely to be triaged as being urgent (P = 0.01). Most attacks were trivial and did not require hospitalization. Antirabies treatment was given in approximately half, analgesics in two fifths, and antibiotics in one fourth. CONCLUSIONS: In mammalian attacks, canines are most commonly involved. Most injuries are trivial, and the limbs are usually involved. However, younger children are at higher risk of facial injuries. Extent of pain and adverse psychological impacts are typically not documented in the emergency assessment.