Introduction
Travel has been identified as the single most important contributor to the spread of the coronavirus disease 2019 (COVID-19) pandemic. Reduction in the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a direct link with the introduction of travel control measures 1. The Wuhan shutdown delayed the occurrence of the first case of SARS-CoV-2 in other cities by 2.91 days (95%CI: 2.54- 3.29 days), an intervention that benefited >130 cities in mainland China, covering more than half its geographic area (Tian et al). Social distancing measures are also a key component of the control strategies during pandemics and form one of the most effective techniques in reducing the number of infections. It is also vital that social distancing and travel restrictions are not lifted prematurely while there is a pool of susceptible hosts in the population, as this will lead to an increase in the number of infections2. When applied to the healthcare sector these measures should aim to reduce hospital attendance by triaging out low risk patients both to protect clinicians and hospitalised patients, while still allowing timely investigations on those deemed to be at higher risk.
Interventions, such as outpatient telemedicine consultations, can reduce footfall in hospitals, thereby promoting adherence to social distancing policies 3. These measures are especially relevant in the cohort of patients with head and neck diseases as the nose and nasopharynx have been shown to be reservoirs for high concentrations of the SARS-CoV-2 4. Reduction of upper aerodigestive tract interventions, including outpatient examinations, is important as many are considered to be aerosol generating procedures5. Additionally, SARS-CoV-2 remains viable in aerosols with a median half-life of 1.1 hours 6, potentially making the examination room a source of infection.
The NHS guidance for managing cancer referrals during the COVID-19 pandemic recommends a telephone triage to minimise interactions and appointments with health services and stream patients for investigations where appropriate 7. Additionally, a telephone appointment with a specialist clinician is accepted as a first appointment for the purposes of recording cancer waiting times for new referrals. As telephone triage is a relatively novel intervention for suspected head and neck cancer, there is currently no established structure to frame this consultation.
The aim of this paper is to demonstrate a rapid implementation of an evidence-based, structured, remote triaging system for assessment of suspected cancer referrals and patients who are on regular follow up after treatment for HNC in the United Kingdom (UK).