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Erben Y, Franco-Mesa C, Hamid O, Lin M, Stone W, Meltzer AJ, Hattery W, Palaj A, Wilshusen LL, Vista TL, Kalra M, Farres H, Bower TC, De Martino RR, Huang JF, Meschia JF, TerKonda SP. Telemedicine in vascular surgery during the coronavirus disease-2019 pandemic: A multisite healthcare system experience. J Vasc Surg 2020; 74:1-4. [PMID: 33338578 PMCID: PMC7738278 DOI: 10.1016/j.jvs.2020.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 12/06/2020] [Indexed: 01/15/2023]
Abstract
Objective To assess the introduction of telemedicine as an alternative to the traditional face-to-face encounters with vascular surgery patients in the era of the coronavirus disease 2019 (COVID-19) pandemic. Methods A retrospective review of prospectively collected data on face-to-face and telemedicine interactions was conducted at a multisite health care system from January to August 2020 in vascular surgery patients during the COVID-19 pandemic. The end point is direct patient satisfaction comparison between face-to-face and telemedicine encounters/interactions prior and during the pandemic. Results There were 6262 patient encounters from January 1, 2020, to August 6, 2020. Of the total encounters, 790 (12.6%) were via telemedicine, which were initiated on March 11, 2020, after the World Health Organization's declaration of the COVID-19 pandemic. These telemedicine encounters were readily adopted and embraced by both the providers and patients and remain popular as an option to patients for all types of visits. Of these patients, 78.7% rated their overall health care experience during face-to-face encounters as very good and 80.6% of patients rated their health care experience during telemedicine encounters as very good (P = .78). Conclusions Although the COVID-19 pandemic has produced unprecedented consequences to the practice of medicine and specifically of vascular surgery, our multisite health care system has been able to swiftly adapt and adopt telemedicine technologies for the care of our complex patients. Most important, the high quality of patient-reported satisfaction and health care experience has remained unchanged.
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Affiliation(s)
- Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla.
| | - Camila Franco-Mesa
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla
| | - Osman Hamid
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla
| | - Michelle Lin
- Department of Neurology, Mayo Clinic, Jacksonville, Fla
| | - William Stone
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Ariz
| | - Andrew J Meltzer
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Ariz
| | - Wendy Hattery
- Center for Connected Care, Mayo Clinic, Jacksonville, Fla
| | - Arta Palaj
- Office of Access Management, Mayo Clinic, Jacksonville, Fla
| | | | - Tafi L Vista
- Patient Experience Research, Mayo Clinic, Jacksonville, Fla
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Houssam Farres
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla
| | - Thomas C Bower
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | | | | | - Sarvam P TerKonda
- Center for Connected Care, Mayo Clinic, Jacksonville, Fla; Division of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, Fla
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Li HL, Chan YC, Huang JX, Cheng SW. Pilot Study Using Telemedicine Video Consultation for Vascular Patients' Care During the COVID-19 Period. Ann Vasc Surg 2020; 68:76-82. [PMID: 32562832 PMCID: PMC7836856 DOI: 10.1016/j.avsg.2020.06.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022]
Abstract
Background The aim of this pilot study was to evaluate the effectiveness and patients satisfaction of using telemedicine virtual communications to provide remote health care to vascular patients during the coronavirus disease 2019 (COVID-19) period in China. Methods Video calls using WeChat software (Tencent, Shenzhen, China) between patients and vascular surgeons were conducted in a period when there were restrictions and limitations for people’ travels in China. At the end of each video call, a short questionnaire was used to evaluate the patient satisfaction level. Results During the COVID-19 period from 19 February to March 16, 2020, a sample of 114 from 165 (69%) patients was reached after one phone call attempt. One hundred forty-two telemedicine remote communications were made between the two vascular surgeons and 114 patients. The mean age of this cohort of patients were 60 ± 15.2 (range 25 to 90) years old, and 74 (65%) were men. Twenty-five patients (22%) were outside of our province when they received the video call. The mean duration of the video call was 11.0 ± 8.9 minutes. All of the patients thought telemedicine was a good substitute for coming to hospital, and 95% (108/114) of them preferred to have remote telemedicine rather than postpone the appointment. All the patients agreed with the advantages of telemedicine including no infection risks, no need to travel, and no need to wait for long time. All the patients were “satisfied” or “highly satisfied” with the video call and they would like to use telemedicine for follow-up in the future. Conclusions Telemedicine virtual communications was effective to provide remote health care with a high patient satisfaction during the COVID-19 period. Telemedicine offers support to vulnerable vascular patients without the need for travel and face-to-face hospital consultation, and so avoided transmission and infection.
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Affiliation(s)
- Hai-Lei Li
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong- Shenzhen Hospital, Shenzhen, China
| | - Yiu Che Chan
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong- Shenzhen Hospital, Shenzhen, China; Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
| | - Jian-Xiong Huang
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong- Shenzhen Hospital, Shenzhen, China
| | - Stephen W Cheng
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong- Shenzhen Hospital, Shenzhen, China; Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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Mousa AY, Broce M, Monnett S, Davis E, McKee B, Lucas BD. Results of Telehealth Electronic Monitoring for Post Discharge Complications and Surgical Site Infections following Arterial Revascularization with Groin Incision. Ann Vasc Surg 2019; 57:160-169. [DOI: 10.1016/j.avsg.2018.09.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/09/2018] [Indexed: 12/21/2022]
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Kaspersen JH, Aasland J, Leira HO, Odegård A, Nagelhus B, Størset G, Lundbom J, Rosenlund TT, Tjora A, Myhre HO. Three-Dimensional Teleradiology for Surveillance Following Endovascular Aortic Aneurysm Repair:A Feasibility Study. J Endovasc Ther 2005; 12:196-9. [PMID: 15823066 DOI: 10.1583/04-1422.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To study the feasibility of 3-dimensional (3D) teleradiology in surveillance of patients treated with stent-grafts for abdominal aortic aneurysm (AAA). METHODS Between April 2002 and November 2003, 8 AAA patients (7 men; median age 73 years, range 62-84) with stent-grafts had follow-up computed tomograms (CT) performed at their local hospital and transmitted without loss across a broadband connection to the university hospital. On both monitors, the radiologists were presented with the complete CT axial dataset, sagittal and coronal reformatted slices, and a 3D volume-rendered reconstruction. The two radiologists were then able to simultaneously perform measurements and real-time manipulations of the axial and 3D pictures, which were discussed over the telephone or using a videoconferencing unit. Patient satisfaction, the radiologists' evaluation of the method, and the potential cost savings were explored. RESULTS Twelve follow-up CT scans were performed on the 8 patients. The time for transmission over the teleradiological network averaged 5 minutes, and the evaluation required 15 minutes at the university hospital. The overall technical quality of the images was rated as good by the university radiologist. In 11 studies, the stent-grafts were satisfactory, but a type III endoleak was detected in one 5.5-year-old stent-graft. Neither radiologist had a problem identifying the endoleak. Patients had confidence that the examination at the local hospital was of good quality; they all felt that they received good care and were pleased with avoiding travel to the university hospital. From the economic analysis, an annual savings of 40,000 Euros (USD 52,304) was projected, mostly due to avoiding hospital stays and outpatient consultations at the university hospital. CONCLUSIONS The experiences from this study are encouraging, but a larger series will be necessary for a thorough evaluation of 3D teleradiology as a surveillance method for aortic stent-graft patients.
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Jong M. Managing suicides via videoconferencing in a remote northern community in Canada. Int J Circumpolar Health 2005; 63:422-8. [PMID: 15709317 DOI: 10.3402/ijch.v63i4.17759] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Telehealth in remote communities has been reported to be cost-effective for emergency medicine and possibly for psychiatry. METHODS The cost of sending a patient out of a remote community for suicide assessment was compared with the cost of maintenance and on-line charges of videoconference. The cost comparison was used to determine the potential savings to the provincial government. User satisfaction was assessed through qualitative questionnaires. RESULTS The use of videoconferencing for mental health assessment for 71 patients in a remote northern community saved the Government of Newfoundland and Labrador dollar 140,088 in 2003. Patients and health professionals were satisfied with mental health assessment via videoconference. CONCLUSION The provision of mental health assessments for patients in a remote community in Labrador, Canada by videoconference was effective and saved money.
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Affiliation(s)
- Michael Jong
- Memorial University of Newfoundland, Labrador Health Center, Canada.
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Bangs I, Baldwin LP, Clarke M, Hands L, Jones RW, Mahaffey W. A Technology-assisted approach to integrating healthcare in the community. Telemed J E Health 2003; 9:215-21. [PMID: 12855044 DOI: 10.1089/153056203766437552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The fragmentary nature of healthcare provision in the United Kingdom presents particular problems for many patients with vascular disease. The management and organization of this disease are also costly for the National Health Service (NHS). Hence, so any attempt to keep hospital visits to the minimum while at the same time aiding effective treatment is to be welcomed. Information in the current NHS is stored in various places and access to it is restricted. There is no central, complete, patient record that is accessible to all healthcare professionals at the various levels of care. There is also no mechanism that allows the patient to interact with his or her local nurse and/or doctor/general practitioner (at primary-care level) involving the specialist/consultant (at secondary-care level). The concept and conduct of an ulcer care program for such patients are described in this paper. Nurse-led, this novel approach uses an innovative information technology system to bring together the isolated 'islands' of knowledge and information held by both the patient and healthcare professionals involved in their care. The technology described here combines both store and forward and real-time video. Informal feedback from patients, community nurses, doctors/general practitioners, and specialists/consultants suggests that such an approach is well received. However, we conclude with a discussion of the complexities involved in the interaction between technology and people and the implications for the management of healthcare.
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Affiliation(s)
- Iris Bangs
- Chorleywood Health Centre, Chorleywood, Hertfordshire, United Kingdom
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Ricci MA, Caputo M, Amour J, Rogers FB, Sartorelli K, Callas PW, Malone PT. Telemedicine reduces discrepancies in rural trauma care. Telemed J E Health 2003; 9:3-11. [PMID: 12699603 DOI: 10.1089/153056203763317602] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patients injured in rural areas die at roughly twice the rate of those patients with similar injuries in urban areas. A multitude of explanations have been suggested for higher mortality rates from trauma in the rural areas of the United States. Since rural emergency room (ER) staff see far fewer traumas than ER staff at large metropolitan trauma centers, their lack of exposure to this low-volume problem certainly contributes to the problem. To address discrepancies in trauma education and the delivery of care in our rural region, a telemedicine system was utilized to provide rapid consultation from surgeons at the level 1 trauma center and to provide enhanced educational opportunities for rural ambulance emergency first responders. Clinical outcome measures and evaluation questionnaires were designed in advance of implementation. Forty-one "tele-trauma consults" were performed over the first 30 months of the project, all for major, multi-system trauma. Though many clinical recommendations were made, the system was judged to be life saving in three instances, and both rural and trauma center providers felt the system enhanced clinical care. In addition, educational sessions for rural first responders were well attended and favorably reviewed. Early results of a telemedicine system provide encouragement as a means to address discrepancies in the outcomes after major trauma in rural areas, although more work needs to be completed and evaluated.
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Affiliation(s)
- Michael A Ricci
- Allen Health Care and the Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont 05405-0068, USA.
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Bangs I, Clarke M, Hands L, Jones R, Knott M, Mahaffey W. An integrated nursing and telemedicine approach to vascular care. J Telemed Telecare 2002; 8 Suppl 2:110-2. [PMID: 12217161 DOI: 10.1177/1357633x020080s250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We have developed a telemedicine approach to vascular care for patients being managed in primary care. District nurses visit patients in their homes. Clinical information and digital photographs can be sent by email to the vascular surgeon for assessment. Where appropriate a preliminary teleconsultation between the patient and a vascular surgeon, with the nurse in attendance, is held at the primary care centre and the management of the patient is agreed. This may include referral to surgery. Over eight months six patients with diabetes and peripheral ulcers participated in the vascular telemedicine clinic. The average consultation time was 12 min (SD 4), which included discussion of the case and negotiation of its management. Important outcomes of the new system were the ability to schedule patients for rapid referral and to have completed the management of the case during the teleconsultation.
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Affiliation(s)
- Iris Bangs
- Chorleywood Health Centre, Hertfordshire, UK
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Thurmond VA, Boyle DK. An Integrative Review of Patients' Perceptions Regarding Telehealth used in their Health Care. Worldviews Evid Based Nurs 2002. [DOI: 10.1111/j.1524-475x.2002.00012.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Samad A, Hayes S, Dodds S. Telemedicine: an innovative way of managing patients with leg ulcers. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2002; 11:S38-52. [PMID: 11979190 DOI: 10.12968/bjon.2002.11.sup1.12248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/01/2002] [Indexed: 11/11/2022]
Abstract
The optimal management of patients with leg ulcers requires a multidisciplinary approach, with contributions from both community and hospital specialists to identify, investigate and treat the underlying causes, provide patient education, assess healing and dress the wounds, monitor outcome and prevent recurrence. However, current practice is impaired by the limited communication between community and hospital specialists. There are inconsistencies in methods of transferring and updating patient records between the hospital and the community, and this can lead to confusion over the diagnosis and appropriate management. Telemedicine, the electronic exchange of medical information at a distance, would appear to offer a way to establish an efficient and effective communication link between hospital and community specialists involved in the care of patients with leg ulcers. The authors of this article believe that modern information technology and the existing NHSnet information infrastructure could be employed to create such a link via electronic patient records.
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Affiliation(s)
- Ajai Samad
- Department of Vascular Surgery, Good Hope Hospital NHS Trust, West Midlands
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Rogers FB, Ricci M, Caputo M, Shackford S, Sartorelli K, Callas P, Dewell J, Daye S. The use of telemedicine for real-time video consultation between trauma center and community hospital in a rural setting improves early trauma care: preliminary results. THE JOURNAL OF TRAUMA 2001; 51:1037-41. [PMID: 11740247 DOI: 10.1097/00005373-200112000-00002] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND By geographic necessity, rural trauma patients must be initially stabilized at local community hospitals before transfer for definitive care. In this study, it was hypothesized that telemedicine consults with trauma surgeons from a Level I trauma center online while the patient was still in the community hospital ED could positively affect care. METHODS Four community hospital emergency departments in upstate New York and Vermont were equipped with dual cameras with remote control capability. Three trauma surgeons' homes were wired and equipped with telemedicine systems. Protocols were developed for the initiation of a telemedicine consult. RESULTS There were 26 telemedicine consults over an 8-month period. The telemedicine population was significantly more severely injured and had a higher mortality than the general trauma population admitted to the Level I trauma center. In two cases, it was felt that the telemedicine consultation was potentially lifesaving. On follow-up, more than 80% of the referring providers felt that the telemedicine consult improved care. CONCLUSION Telemedicine provides a virtual online trauma surgeon to assist with the resuscitation and stabilization of the major trauma patient in a small community hospital. These preliminary results show a positive impact on rural trauma patient care at the local community hospital.
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Affiliation(s)
- F B Rogers
- Department of Surgery, Fletcher Allen Health Care, University of Vermont, Burlington, Vermont 05401, USA.
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12
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Endean ED, Mallon LI, Minion DJ, Kwolek CJ, Schwarcz TH. Telemedicine in Vascular Surgery: Does it Work? Am Surg 2001. [DOI: 10.1177/000313480106700407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Telemedicine (TM) using closed-circuit television systems allows specialists to evaluate patients at remote sites. Because an integral part of the vascular examination involves palpation of peripheral pulses the applicability of TM for the evaluation of vascular surgery patients is open to question. This study was carried out to test the hypothesis that TM is as effective as direct patient examination for the development of a care plan in vascular patients. Sixty-four vascular evaluations were done in 32 patients. The patients presented with a variety of vascular problems and were seen in regularly scheduled rural outreach vascular clinics. Two faculty vascular surgeons evaluated each patient; one was on site and the second, using TM, remained at the medical center. Each surgeon was blinded to the other's findings. The TM physician was aided by a nonphysician assistant, who obtained blood pressures, utilized a continuous-wave Doppler probe, positioned the patient, and operated the TM equipment. The results of each surgeon's evaluations were compared. Patient and physician satisfaction with the TM evaluation was appraised by questionnaires. Eight patients were seen for initial evaluations; 24 patients were seen for follow-up visits. Patients were seen with a variety of diagnoses, including aneurysm (seven), cerebrovascular disease (five), lower extremity occlusive disease (13), multiple vascular problems (three), and other disease (four). The average duration for the TM and on-site evaluations were 20.6 ± 1.4 and 19.0 ± 1.3 minutes, respectively ( P = not significant). Physician concordance, as determined by treatment recommendations, was the same in 29 (91%) patients. Physician confidence in the ability to obtain an accurate history via TM was rated as excellent in 97 per cent; confidence in the TM physical examination was rated as excellent in 70 per cent. All patients rated the TM evaluation as the “same as” or “better than” the on-site examination, and all indicated a preference for being seen locally using TM as opposed to traveling to a regional medical center. We conclude that the TM evaluation of vascular patients is accurate and is as effective as on-site evaluations for a variety of vascular problems. Important adjuncts to enhance the success of a TM evaluation are physician experience with the technology and the presence of a knowledgeable on-site assistant. This technology can be easily adapted to other clinical situations.
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Affiliation(s)
- Eric D. Endean
- Department of Surgery, Section of Vascular Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Lawrence I. Mallon
- Department of Surgery, Section of Vascular Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - David J. Minion
- Department of Surgery, Section of Vascular Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Christopher J. Kwolek
- Department of Surgery, Section of Vascular Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Thomas H. Schwarcz
- Department of Surgery, Section of Vascular Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
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Rosser JC, Prosst RL, Rodas EB, Rosser LE, Murayama M, Brem H. Evaluation of the effectiveness of portable low-bandwidth telemedical applications for postoperative followup: initial results. J Am Coll Surg 2000; 191:196-203. [PMID: 10945365 DOI: 10.1016/s1072-7515(00)00354-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The idea of using telemedical applications to evaluate patients remotely is several decades old. It has already been established that x-ray images (and magnetic resonance images) can be transferred using a personal computer and a modem, and many other such applications have been implemented. Over the past 50 years the expense and technical demands of the equipment involved in telemedicine have hindered its widespread deployment. The purpose of this study is to evaluate the ability of a mobile, low-bandwidth telemedicine platform to achieve real-time postoperative visits in the home. STUDY DESIGN This evaluation was designed to evaluate the feasibility of performing a real-time clinical visit with computer and telecommunications hardware and software. A nurse and medical student (for information gathering only) made postoperative visits at patients' homes while the physician stayed at the office. Clinical evaluations were performed by using low-resolution and frame-rate video, high-resolution still images, and simultaneous telephony over a standard telephone line. These remote visits were followed by a standard visit in the office. Eleven patients were included, all of whom had undergone various laparoscopic procedures. They lived 5 to 240 miles from their surgeon. Efficiency was measured by recording the time required to capture and send data required by the physician to make a clinical decision. The time expense was measured at both the patients' and physician's locations. Technical issues were evaluated and patient satisfaction was assessed by standardized objective questionnaires. The accuracy of the evaluation at the remote visit was determined with a standard office visit. RESULTS No technical problems were observed. The mean total time of the housecall at the remote site was 86 minutes (range 60 to 160 minutes) and at the base station site was 41 minutes (range 21 to 71 minutes). After personnel became familiar with the system, the last three visits averaged 61 and 25 minutes at the two sites, respectively. This corresponds favorablywith current time requirements for visiting nurses and office visits. The patients were highly satisfied with the home visit and, on average, rated the experience as 4.8 out of a maximum of 5. CONCLUSIONS Followup visits in patients' homes after laparoscopic procedures can be accomplished by transmitting simultaneous voice, low-resolution video, and high-resolution still images to accurately perform postoperative evaluations over standard telephone lines, with time requirements and clinical accuracy similar to those of standard visits.
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Affiliation(s)
- J C Rosser
- Department of Surgery, Yale University, New Haven, CT, USA
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