Video consultations – top tips for clinicians

A webinar organised by the Innovation Agency to explore the pros and cons of using online video platform Attend Anywhere led to the compilation of ‘top tips’ from our speakers.

The webinar heard from three paediatricians in Lancashire and South Cumbria; a patient and her mum; and the NHS lead for rolling out Attend Anywhere in the North West.

Below, are tips from our speakers on how to get the most out of a video consultation.

From NHS digital lead Daniel Hallen: Your performance

Consider your surroundings. Are you in a comfortable environment that allows you to have an open conversation with your patient or health care professional that others won’t overhear or intrude upon?

Look at the camera lens often - but not all the time.  It’s natural to look at the video of the other person (or even yourself) but do make sure you look at the camera to engage eye contact.

It is helpful to have two screens, one for the consultation, the other to look at notes and results of X-rays etc.

You need good quality audio and video and good wifi.

From patient Imogen and mum Rachel: Getting ready and waiting

The waiting room works well, and it helped that we received a message that reception knew that we were in a queue.

We waited 20 minutes for one appointment and were getting anxious that we had been forgotten about. We thought the team may have been waiting but the receptionist had forgotten about us. If a patient has waited more than five or ten minutes, perhaps there could be a way of communicating either via chat or face to face with the patient to reassure them that they had not been forgotten. I did ring a number to check whether we had been forgotten about, however it wasn’t answered.

If a physical examination or assessment is needed, the patient must have another person present to hold the camera, unless they have an effective means of securing and positioning their camera.

If equipment is needed for the appointment, for example weighing scales, this should be advised in advance of the appointment, so everything is there ready.

You could have a short video presentation for clinicians and patients, explaining protocols for an effective call.

From patient Imogen and mum Rachel: During the consultation

Imogen and I wonder if there should be a limit on the number of people present; in one appointment, we were a family of three with a team of two. This worked well, however if there were any more I wonder if the conversation could get stilted, as people don’t quite know when to speak, or who is next. I guess this process could be carefully managed with people having clear slots in which to speak.

All our clinicians talked to us in a relaxed manner and passed the time of day before the appointment, this meant that we were relaxed when the appointment began.

In the webinar, it was mentioned that appointments could be held in libraries, using the public computers. I actually work for Lancashire Libraries; all our computers are accessed in public places and there is no privacy. I have helped people to acquire their blue badges and have worried about the amount of personal information that customers are prepared to provide in public. I think this would only work if the NHS and the Council could provide some sort of sound proof booth that could be booked for hospital and other private appointments. I do also wonder if the public network bandwidth would be large to cope with a video call.

From the clinicians: In advance of the consultation

For a multidisciplinary team meeting, you can invite any other professional or local team, or other family members or community workers.

It is important to have good admin support to make it work. There is often more for the admin team to do, not less. For example they will need to ensure that patients understand what to expect; receive timely reminders; have all the information they need and are in the correct online waiting room while waiting for their appointment.

Always make sure that the attendees respect the importance of the consultation so that they are not just dialling in from the supermarket checkout or while sitting on a bus; the patient needs to be in an appropriate environment.

In paediatrics, it is very important to ensure the child is part of the consultation, even if he or she is young.

Always prepare for your clinics; double check that the appropriate mode is being used - look through the patient’s records beforehand.

Ensure adequate robust training of all staff, especially admin and management staff; make sure you have appropriate and adequate resources.

Ensure buy-in from all the clinicians so that there is equity for the patients and families.

Ensure appropriate instructions and information is sent to the family beforehand.

During the consultation

Examinations: You can do many examinations on video, including quite a good neurological exam. Seeing patients in their own environment means they may be more at ease and you gain a clearer picture of their problems in context.

You can quickly switch to the phone as a fall back or else arrange a face to face appointment.

Make sure you are talking to the correct patient and carer and spend some time explaining how the consultation is going to work before you start.

Clarify expectations and timings of the consultation, explain that you have other patients waiting.

Be clear at the end of the consultation about what happens next and what form of follow up is needed, ie face to face, phone or video.

Explain that you may need to set up a face to face appointment to examine them at a later date.

Ensure that you maintain confidentiality.

Be prepared for a situation in which the patient and/or family may want to record the consultation.

Dr Christian DeGoede:
“In our phone consultations we often end up just speaking with parents, sometimes the child is not even in the room. With the video, it is much easier to include the child. I have found this a very positive aspect of video over phone.”

Dr Clare Peckham:
“Always allow the parents/patients/carers the choice of mode of consultation they want – don’t force a video consultation on them, it’s not for everyone.”

Dr Chris Gardner:
“It’s always important to make sure other people in the room with you are also on camera and that you introduce them, just as you would if they were sitting in the clinic room face to face with the patient.”

Advice from:

Daniel Hallen: Head of Digital Technology, NHS England and Improvement

Imogen and Rachel Gray

Dr Christian DeGoede: Consultant Paediatric Neurologist, and Paediatric Lead for the Lancashire and South Cumbria Integrated Care System

Dr Chris Gardner: Consultant Paediatrician, East Lancashire Hospitals NHS Trust

Dr Clare Peckham: Consultant Paediatrician and Lead for Respiratory Paediatrics including Cystic Fibrosis, at Royal Lancaster Infirmary, part of University Hospitals of Morecambe Bay NHS Foundation Trust

More great advice about video consultations here:

From MDU: https://www.themdu.com/guidance-and-advice/guides/conducting-remote-consultations?gclid=CjwKCAjwt-L2BRA_EiwAacX32UVf4nyGiedKcDYfKk55SOqFfmuxXxIAfm1Bk_AKaynjHLxK-N82UxoCdtwQAvD_BwE

From GMC: https://www.gmc-uk.org/ethical-guidance/learning-materials/remote-consultations-flowchart