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\begin{document}

\title{Safe implementation of index telephone clinic appointments for patients
with suspected lower gastrointestinal cancer with concurrent financial
and environmental benefits.}



\author[1]{Kasun Wanigasooriya}%
\author[1]{Diwakar Sarma}%
\author[1]{Peter Woods}%
\author[1]{Paul O'Connor}%
\author[1]{Adrian Matthews}%
\author[1]{Muhammad Imran Aslam}%
\author[1]{Carolyn Dando}%
\author[1]{Henry Ferguson}%
\author[1]{James Francombe}%
\author[1]{Neeraj Lal}%
\author[1]{Paul Murphy}%
\author[1]{Trifonas Papettas}%
\author[1]{Sean Ramcharan}%
\author[1]{Karen Busby}%
\affil[1]{South Warwickshire NHS Foundation Trust}%


\vspace{-1em}



  
  \date{May 07, 2024}


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\begin{abstract}
Aims: The COVID-19 pandemic led to hospitals in the United Kingdom
substituting face-to-face (FtF) clinics with virtual clinic (VC)
appointments. We evaluated the impact of virtual two-week wait (2-ww)
lower gastrointestinal (LGI) consultations on stakeholders at a district
general hospital in England. Methods: Patients undergoing index
outpatient 2-ww LGI clinic assessment between 01/06/2019-31/10/2019 (FtF
group) and 01/06/2020-31/10/2020 (VC group) were identified. Relevant
data were obtained using electronic patient records. Compliance with
national cancer waiting time targets (WTT) was assessed. Environmental
and financial impact analyses were performed. Results: In total, 1531
patients were analysed (median age=70, male=852, 55.6\%). Of these, 757
(49.4\%) were assessed virtually via telephone; the remainder were seen
FtF (n=774, 50.6\%). Ninety two (6\%, VC=44, FtF=48) patients had
malignant pathology and 64 (4.2\%) had colorectal cancer (CRC); of
these, 46 (71.9\%, VC=26, FtF=20) underwent treatment with curative
intent. The median waiting times to index appointment, investigation and
diagnosis were significantly lower following VC assessment
(p\textless{}0.001). The cancer detection rates (p=0.749), treatments
received (p=0.785) and median time to index treatment for CRC patients
(p=0.156) were similar. A significantly higher proportion of patients
were seen within two weeks of referral in the VC group
(p\textless{}0.001). VC appointments saved patients a total of 9288
miles, 0.7 metric tonnes of CO2 emissions and \selectlanguage{ngerman}£7482.97. Taxpayers saved
£80,242.00 from VCs. No adverse events or complaints were reported in
the VC group. Conclusion: Virtual 2-ww LGI clinics were effective, safe
and were associated with tangible environmental and financial benefits
for stakeholders.%
\end{abstract}\selectlanguage{ngerman}%



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