Introduction
The COVID-19 pandemic is an unprecedented event that has led to an abrupt and drastic shift in the practice of medicine around the world. In an effort to balance the ongoing need for patient care with the risks to patient and staff safety, the CDC and multiple societies, including the American Academy of Otolaryngology – Head and Neck Surgery and the American Head and Neck Society, have issued recommendations to delay elective ambulatory provider visits or to consider telephone or video-based alternatives.1–3 In response, telemedicine has been rapidly implemented and widely adopted in many ambulatory practices for the first time.
The World Health Organization broadly defines telemedicine as the delivery of health care services by all health care professionals using technology for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries.4 As an alternative to the traditional office encounter, telemedicine refers to a live (synchronous), two-way, interactive audio and video-based communication between the patient and the clinician to deliver care at a distance. While telemedicine has been successfully used in many fields over the past two decades, including some surgical subspecialties,5–7 its use has been less widespread in otolaryngology8 despite studies demonstrating that many otolaryngology diagnoses are amenable to virtual appointments9 and that telemedicine provides a significant cost savings and reduction in unnecessary office visits.10–12 This is in part due to difficulty of physical examinations in otolaryngology that often require equipment and training to perform.13
Prior to COVID-19, patient-facing telemedicine in otolaryngology has been largely limited to the delivery of care to remote areas,14 primary provider-to-specialist provider consultations10,12 or under specific circumstances, for instance in Navy military centers and shipboard medical departments15,16 or in the aftermath of Hurricane Katrina.17 Telemedicine in otolaryngology has less commonly focused on synchronous, interactive otolaryngology patient visits in general18–23 and few studies directly examine patient satisfaction.13,19–21,23
The sudden and sweeping transition to telemedicine in light of COVID-19 presents a unique opportunity to explore the role of telemedicine in otolaryngology ambulatory practices and patient satisfaction with virtual visits. Patient satisfaction is an important metric of healthcare quality and can play a major role in the long-term acceptance and success of a telemedicine program. As telehealth grows in prevalence and becomes further integrated into healthcare systems, it is important to preserve patient satisfaction across healthcare delivery modalities. Cursory examinations of patient satisfaction in prior studies have found high rates of patient satisfaction but these studies are limited by their small sample sizes and choice of patient satisfaction metrics.19–21,23 This study systematically explores patient satisfaction with video-based telemedicine visits during COVID-19 utilizing a validated telemedicine satisfaction survey in patients presenting to an academic head and neck surgery practice.