Rapid implementation of an evidence-based remote triaging system for assessment of suspected referrals and patients with head and neck cancer on follow-up after treatment during the COVID-19 pandemic: Model for international collaboration

Vinidh Paleri; John Hardman; Theofano Tikka; Paula Bradley; Paul Pracy; Cyrus Kerawala

doi:10.1002/hed.26219

Rapid implementation of an evidence-based remote triaging system for assessment of suspected referrals and patients with head and neck cancer on follow-up after treatment during the COVID-19 pandemic: Model for international collaboration

Head Neck. 2020 Jul;42(7):1674-1680. doi: 10.1002/hed.26219. Epub 2020 May 11.

Authors

Vinidh Paleri^{1

2

3

4}, John Hardman^{1

2}, Theofano Tikka^{5

6}, Paula Bradley⁷, Paul Pracy^{3

8}, Cyrus Kerawala^{1

4}

Affiliations

¹ Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
² Institute of Cancer Research, London, UK.
³ ENT UK Head and Neck Society, London, UK.
⁴ British Association of Head and Neck Oncologists, London, UK.
⁵ Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK.
⁶ School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK.
⁷ Northumbria GP Rotation, University of Sunderland, Sunderland, UK.
⁸ Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Abstract

Background: Outpatient telemedicine consultations are being adopted to triage patients for head and neck cancer. However, there is currently no established structure to frame this consultation.

Methods: For suspected referrals with cancer, we adapted the Head and Neck Cancer Risk Calculator (HaNC-RC)-V.2, generated from 10 244 referrals with the following diagnostic efficacy metrics: 85% sensitivity, 98.6% negative predictive value, and area under the curve of 0.89. For follow-up patients, a symptom inventory generated from 5123 follow-up consultations was used. A customized Excel Data Tool was created, trialed across professional groups and made freely available for download at www.entintegrate.co.uk/entuk2wwtt, alongside a user guide, protocol, and registration link for the project. Stakeholder support was obtained from national bodies.

Results: No remote consultations were refused by patients. Preliminary data from 511 triaging episodes at 13 centers show that 77.1% of patients were discharged directly or have had their appointments deferred.

Discussion: Significant reduction in footfall can be achieved using a structured triaging system. Further refinement of HaNC-RC-V.2 is feasible and the authors welcome international collaboration.

Keywords: COVID-19; follow-up; new referrals; outpatient consultation; triaging.

MeSH terms

Betacoronavirus
COVID-19
Clinical Decision-Making
Continuity of Patient Care*
Coronavirus Infections / epidemiology*
Evidence-Based Practice
Head and Neck Neoplasms / diagnosis*
Head and Neck Neoplasms / epidemiology*
Humans
Medical Oncology / methods
Pandemics
Pneumonia, Viral / epidemiology*
Predictive Value of Tests
Referral and Consultation*
Remote Consultation
Risk Assessment / methods*
SARS-CoV-2
Symptom Assessment
Triage / organization & administration*
United Kingdom / epidemiology