Paik Angie M, Granick Mark S, Scott Sandra
1 Brown University, Alpert Medical School, Providence, RI; Department of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
2 Department of Surgery, Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
J Telemed Telecare. 2017 Feb;23(2):321-327. doi: 10.1177/1357633X16639459. Epub 2016 Jul 8.
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.
整形外科是一个特别适合远程医疗环境的领域，因为视觉检查和X光片有助于正确的诊断和治疗。本研究的目的是评估通过iPad应用程序进行的与整形外科相关会诊的远程医疗反馈。在一个月的时间里开展了一项质量保证/质量改进（QA/QI）研究，在此期间，对一级创伤中心和大学医院急诊科收治的手部损伤、面部损伤或急性伤口患者进行了监测。该研究使用了一款商业iPad应用程序，通过它可以向远程整形外科教育工作者（PSE）发送多达四张图像和简要病史以供评估。PSE会回复最佳实践信息、参考文献和视频，以协助急诊科即时护理人员。在本研究的1个月期间，共有42例因整形外科疾病进行的急诊科会诊。会诊医生和PSE之间的总体平均响应时间存在高度显著差异（分别为48.3分钟和8.9分钟，p < 0.001）。PSE与会诊医生在患者评估和护理方面的一致性，面对面会诊为85.7%，电话会诊为100%。在4例电话会诊中，急诊科医护人员对手部受伤患者夹板固定不当。我们的结果表明，基于数字图像和简要病史向远程整形外科医生进行的远程医疗会诊能够在急诊护理机构中及时给出准确的回复。这种设计可能会对农村地区、服务不足人群或国外地区产生重大影响。
