Plastic surgery telehealth consultation expedites Emergency Department treatment

• Published in: Journal of telemedicine and telecare Vol. 23; no. 2; p. 321
• Main Authors: Paik, Angie M, Granick, Mark S, Scott, Sandra
• Format: Journal Article
• Language: English
• Published: England 01.02.2017
• Subjects: Computers, Handheld; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - statistics & numerical data; Facial Injuries - surgery; Hand Injuries - surgery; Humans; Quality Assurance, Health Care; Quality Improvement; Remote Consultation - methods; Surgery, Plastic - methods; Time Factors; Wounds and Injuries - surgery; Telehealth; Telemedicine; plastic surgery; Emergency Consultation; Quality Assurance/Quality Improvement (QA/QI)
• ISSN: 1758-1109
• DOI: 10.1177/1357633X16639459

Plastic surgery is a field that is particularly amenable to a telehealth milieu, as visual exam and radiographs guide proper diagnosis and management. The goals of this study were to evaluate telehealth feedback executed through an iPad app for plastic surgery-related consultations. A Quality Assurance/Quality Improvement (QA/QI) study was conducted over a 1-month period during which patients with hand injuries, facial injuries, or acute wounds presenting to the Emergency Department (ED) of a level-one trauma centre and university hospital were monitored. The study utilized a commercial iPad application through which up to four images and a brief history could be sent to a remote Plastic Surgery Educator (PSE) for evaluation. The PSE would respond with best practice information, references and videos to assist ED point-of-care providers. During the 1-month period of this study, there were 42 ED consultations for plastic surgical conditions. There was a highly significant difference in overall mean response time between consultants and PSEs (48.3 minutes vs. 8.9 minutes respectively, p < 0.001). The agreement between PSEs and consultants regarding patient assessment and care was 85.7% for in-person consultations and 100% for phone consultations. In four cases of telephone consultations, the ED providers placed splints incorrectly on hand-injured patients. Our results show that telehealth consultations to a remote plastic surgeon based on digital images and a brief history were able to produce timely and accurate responses in an emergency care facility. This design may have significant impact in rural areas, underserved populations, or regions abroad.