Clinical Outcomes and Resource Efficiency of a Telehealth Model for New Lower Gastrointestinal Bleeding Referrals: A Tertiary Colorectal Outpatient Service Audit

Introduction: Amidst the COVID-19 pandemic, telehealth (TH) has gained increasing relevance in colorectal patient care, prompting an audit of the TH clinic at a tertiary colorectal unit. This study evaluated telephone-based consultations' clinical efficacy and diagnostic thresholds for new lower gastrointestinal (LGI) bleeding referrals. Methods: We conducted a quality assurance audit of the per rectal (PR) bleeding TH clinic at Northern Hospital Victoria, evaluating new LGI bleeding referrals. Data from July 2021 to June 2023 were extracted from the Referral Management System (RMS) and analyzed. The study focused on newly referred patients, excluding those previously seen or awaiting procedures. Clinical efficacy was determined through sensitivity, specificity, and predictive values, with a receiver operating characteristic (ROC) curve assessing the TH method's discrimination threshold. Results: Of the 239 patients, 131 met the inclusion criteria, with a compliance rate of 96%. The TH clinic demonstrated a sensitivity of 75.76% and specificity of 52.46% in distinguishing between colorectal and anal pathologies. The average time from referral to a diagnostic procedure was 9.75 weeks, with a reduction in median wait time for first appointments from 19 weeks prepandemic to 3.6 weeks. A cost-benefit analysis highlighted TH clinics' ability to reduce overhead costs and maintain a revenue stream despite reduced face-to-face consultations. Conclusion: Our study concludes that the telecare service model serves as an effective complementary approach for managing new LGI bleeding referrals. Further research on long-term outcomes and cost-effectiveness is necessary to fully assess telecare as a potentially sustainable hybrid model.