Martinez R, Rogers A D, Numanoglu A, Rode H
The Burn Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; The Division of Paediatric Surgery, Department of Surgery, University of Cape Town, South Africa.
The Ross Tilley burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; The Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Canada.
Burns. 2018 Jun;44(4):947-955. doi: 10.1016/j.burns.2017.11.005. Epub 2018 Feb 1.
Telemedicine is increasingly applied in developed settings to facilitate transfer of information to and from burn surgeons across vast geographic areas. WhatsApp is a widely available and extremely user-friendly encrypted smartphone application that does not require the expensive physical and personnel infrastructure that characterizes many of these telemedicine systems. The aim of this study was to review the use of WhatsApp to facilitate paediatric burn injury consultations to a regional burn centre in a developing country, where burn care continues to be thwarted by administrative apathy, poor resource allocation and lack of attention to medical and nursing education at all levels.
A retrospective review was undertaken of all consultations using WhatsApp over an 18-month period, received by the burn centre's two senior medical practitioners. The specific origin and nature of the telemedicine requests for advice, transfer or follow-up were collected, as were data relating to the demographics of the patients, the aetiology, mechanism and extent of the burn injury. The impact of the system of communication in terms of reductions in admissions and clinic visits was assessed, and a cost analysis was undertaken. Feedback was also obtained from those health practitioners regularly using the service.
838 communications occurred during the study period, which included 1562 distinct clinical queries. 486 interactions (58%) originated from within the hospital, the majority of which were initiated by surgeons in training or burn nurse practitioners. 352 (42%) consultations were from outside the hospital. Queries related to the full spectrum of burn care, including emergency management and stabilization, triage and transfer, the need for escharotomy, fluid resuscitation, wound care, the timing and nature of surgical intervention, as well as follow-up and rehabilitation. While no significant changes in the number of surgical interventions or admissions were observed when compared to the five years prior to the intervention, outpatient visits reduced significantly during the study period. It was estimated that over 150 unnecessary admissions were also avoided as a result of the triage made possible by WhatsApp, which translated into considerable cost saving for the institution.
Incorporating WhatsApp technology into the daily processes of burn care has significantly improved the quality of paediatric burn care referrals to specialist burn services. Specifically, WhatsApp has contributed to reductions in unnecessary referrals and outpatient visits, facilitated opportunities for continuing medical education, improved the care of major burn injuries through more effective prehospital communication, and enabled greater allocation of scarce specialist resources at the burn centre. This study motivates for the wider application of WhatsApp for burn care referrals, especially in developing countries.
远程医疗在发达地区的应用日益广泛，有助于在广阔地理区域内与烧伤外科医生之间传递信息。WhatsApp是一款广泛使用且极为用户友好的加密智能手机应用程序，无需许多此类远程医疗系统所特有的昂贵实体设施和人员配置。本研究的目的是回顾在一个发展中国家，利用WhatsApp为一家地区烧伤中心提供儿科烧伤咨询服务的情况，在该国，烧伤护理因行政冷漠、资源分配不当以及各级对医学和护理教育缺乏关注而受到阻碍。
对烧伤中心的两名高级医生在18个月期间通过WhatsApp进行的所有咨询进行回顾性研究。收集远程医疗咨询建议、转诊或随访的具体来源和性质，以及与患者人口统计学、烧伤病因、机制和程度相关的数据。评估通信系统在减少住院和门诊就诊方面的影响，并进行成本分析。还从定期使用该服务的医疗人员那里获得反馈。
研究期间共发生838次通信，包括1562个不同的临床问题。486次互动（58%）来自医院内部，其中大多数由实习外科医生或烧伤护理从业者发起。352次（42%）咨询来自医院外部。问题涉及烧伤护理的各个方面，包括急诊处理与稳定、分诊与转诊、焦痂切开术的必要性、液体复苏、伤口护理、手术干预的时机和性质，以及随访与康复。与干预前五年相比，手术干预次数和住院人数没有显著变化，但研究期间门诊就诊人数显著减少。据估计，由于WhatsApp实现的分诊，还避免了150多次不必要的住院，为该机构节省了可观的成本。
将WhatsApp技术纳入烧伤护理的日常流程，显著提高了儿科烧伤护理转诊到专科烧伤服务的质量。具体而言，WhatsApp有助于减少不必要的转诊和门诊就诊，为继续医学教育提供了机会，通过更有效的院前沟通改善了严重烧伤的护理，并使烧伤中心能够更合理地分配稀缺的专科资源。本研究促使更广泛地应用WhatsApp进行烧伤护理转诊，尤其是在发展中国家。
