From the Division of Plastic Surgery and The Value Institute Learning Center, Dartmouth-Hitchcock Medical Center; the Geisel School of Medicine at Dartmouth; and Yale Plastic and Reconstructive Surgery.
Plast Reconstr Surg. 2019 Aug;144(2):507-516. doi: 10.1097/PRS.0000000000005884.
Telemedicine delivers clinical information and permits discussion between providers and patients at a distance. Postoperative visits may be a burden to patients-many of whom travel long distances and miss work opportunities. By implementing a telehealth opportunity, the authors sought to develop a process that optimizes efficiency and provides optimal patient satisfaction.
Using quality improvement methods that have been highly effective in the business sector, we developed a testable workflow for patients in the postoperative telehealth setting. Seventy-two patients were enrolled and surveyed. A preoperative survey sought to determine travel distance, comfort with technology, access to the Internet and video-enabled devices, and the patient's interest in telehealth. A postoperative survey focused on patient satisfaction with the experience.
Using the Lean Six Sigma methodology, the authors developed a telehealth workflow to optimize clinical efficiency. Preoperative surveys revealed that the majority (73 percent) of patients preferred in-person follow-up visits in the clinic. However, the postoperative survey distributed after the telehealth encounter found that nearly 100 percent of patients were satisfied with the telehealth experience. Ninety-six percent of patients said that their questions were answered, and 97 percent of patients stated that they would use telehealth again in the future.
Telehealth encounters enable real-time clinical decision-making by providing patients and visiting nurses access to providers and decreasing patient transportation needs and wait times. Although initially hesitant to opt for a telehealth encounter in lieu of a traditional visit, the great majority of patients voiced satisfaction with the telehealth experience.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
远程医疗提供了临床信息，并允许医疗服务提供者和患者远距离进行交流。术后随访可能会给患者带来负担——许多患者需要长途跋涉并错过工作机会。通过实施远程医疗机会，作者寻求开发一种能够优化效率并提供最佳患者满意度的流程。
作者使用在商业领域非常有效的质量改进方法，为术后远程医疗环境中的患者开发了一个可测试的工作流程。共有 72 名患者参与并接受了调查。术前调查旨在确定患者的旅行距离、对技术的舒适度、互联网和视频设备的使用情况，以及患者对远程医疗的兴趣。术后调查则侧重于患者对体验的满意度。
作者使用精益六西格玛方法开发了一种远程医疗工作流程，以优化临床效率。术前调查显示，大多数（73%）患者更喜欢在诊所进行面对面的随访。然而，在远程医疗就诊后进行的术后调查发现，近 100%的患者对远程医疗体验感到满意。96%的患者表示他们的问题得到了回答，97%的患者表示将来会再次使用远程医疗。
远程医疗就诊使患者和探访护士能够与医疗服务提供者实时进行临床决策，同时减少了患者的交通需求和等待时间。尽管最初对选择远程医疗就诊而不是传统就诊犹豫不决，但绝大多数患者对远程医疗体验表示满意。
临床问题/证据水平：治疗性，IV 级。
