Low failure to attend rates and increased clinic capacity with Telehealth: A highly effective outpatient model that should continue beyond the COVID‐19 pandemic

We read with interest the article from Zorron Cheng Tao Pu and colleagues on the benefits of phone consultation for two hospital-based endoscopy clinics during the COVID-19 pandemic.1 The authors demonstrated reduced overall failure to attend rates (FTAs, 6.4% vs 12.6%, P < 0.01) during the COVID-19 outbreak with telephone consultations compared with face-to-face consultations in the pre-COVID era. Failure to attend is expensive and resource demanding, with reported FTAs up to 30% in some centers.2, 3 In Western Australia, 160 000 outpatient appointments were FTAs at public hospital clinics over 12 months, resulting in $26 million in lost productivity.4 Non-attendance is influenced by many factors, including logistics surrounding attendance, work commitments, financial hardship, transportation access, competing health interests, change in clinical need for review, and forgetfulness.5, 6 Telehealth can be conducted via videoconferencing or telephone and represents an attractive model to reduce FTAs and increase outpatient clinic throughput, which is important given the long waiting times for many clinics, and the financial ramifications of missed appointments. However, telehealth may not be appropriate or feasible for all patients, including persons who are elderly, culturally and linguistically diverse, itinerant or homeless, from low socioeconomic backgrounds, have poor health literacy, and who may not have ready access to or be able to navigate telehealth. It also may not be suitable for certain hospital outpatient disciplines. Therefore, we aimed to build on the work of Zorron Cheng Tao Pu and colleagues by evaluating FTAs across a wider range of gastroenterology clinics including a broader patient demographic and larger cohort and encompassing all major gastrointestinal outpatient services. Furthermore, we compared FTAs between the different telehealth modalities (videoconferencing vs telephone consultations) during the COVID-19 period, in addition to comparing telehealth with face-to-face consultations over the past 5 years. At our institution, the COVID-19 pandemic triggered the immediate and almost universal implementation of the telehealth model of care for outpatient appointments. We evaluated the efficiency of telehealth at a single tertiary hospital in Melbourne, Australia, over a 9-week period during the first COVID-19 lockdown, focusing on the impact of telehealth on the number of scheduled appointments and clinic FTAs across all 13 gastroenterology outpatient clinics encompassing inflammatory bowel disease, hepatology, hepatoma, general gastroenterology, endoscopy, and functional gut disorders. Over the 9-week period, the total number of scheduled outpatient appointments and FTAs were compared with the average numbers over the same time period during the preceding 5 years. Data collected included total number of appointments scheduled, FTAs, and appointment type (videoconferencing, telephone, or face-to-face consultations). A total of 2626 outpatient clinic appointments were scheduled during the 9-week study period, with 2237 (85.2%) appointments attended and 389 (14.8%) FTAs, representing a 2.2% improvement in attendance rate compared with the average attendance rate during the same 9-week time period in the preceding 5 years (P = 0.035). Of the 2626 appointments in the COVID-19 era, 1319 (50.2%) were videoconferencing consultations and 1307 (49.8%) were telephone consultations. When evaluating the appointment type, we found that consultations carried out by telephone resulted in significantly lower FTAs compared with videoconferencing consultations (9.0% vs 20.6%; P < 0.001). In the preceding 5 years, an average of 2304 outpatient clinic appointments (395 fewer appointments) were scheduled during the same 9-week period, with 1912 (83.0%) appointments attended and 392 (17.0%) FTAs. Of the 2304 appointments, only 33 (1.4%) were videoconferencing consultations, despite the availability of videoconferencing appointments. In keeping with the findings of Zorron Cheng Tau Pu and colleagues,1 we found that rapid and almost universal implementation of the telehealth model resulted in a dramatic and significant overall reduction in FTAs over a very short period of time across all 13 gastroenterology outpatient clinics, primarily driven by reduced FTAs with telephone consultations. Furthermore, an additional 395 clinic appointments occurred during the evaluated 9-week period compared with previous 5 years, demonstrating increased appointment capacity with the telehealth model. Our data demonstrate that the telehealth model is highly efficient and provides a strong case for ongoing state and federal government support beyond the COVID-19 pandemic, importantly including both videoconferencing and telephone consultation, as well as expansion beyond current patient eligibility criteria to allow all patients to access telehealth where appropriate. This will improve efficiency and reduce the financial burden associated with missed outpatient appointments.