Hoerter Jacob E, Debbaneh Peter M, Liu Kalena, Shah Swapnil, Weintraub Miranda, Jiang Nancy
Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center , Oakland, CA, USA.
City University of New York School of Medicine , New York, NY, USA.
Perm J. 2024 Dec 16;28(4):31-37. doi: 10.7812/TPP/24.077. Epub 2024 Sep 18.
The integration of virtual visits has been met with skepticism by many surgical specialties, including otolaryngology, due to the lack of a complete physical exam. Analysis of differences in the workup between patients triaged virtually or in-person is warranted.
A chart review was performed for a cohort of adults undergoing septoplasty (January 2021-May 2022). Groups (telemedicine, in-person) were compared by 2-sample -test and chi-square test to determine the difference in the number of preoperative visits and to assess the variation in patients with preoperative laboratory testing, imaging, or referrals.
Of 338 patients, initial evaluation was in-person for 225 (66.5%) and via telemedicine for 113 (33.5%). The groups were similar in demographics (mean age 39.1 years for telemedicine vs 38.8 years for in-person, female 28.9% vs male 37.7%, = 0.088). The telemedicine group had a significantly higher number of preoperative visits (3.03) compared to the in-person group (2.38, = 0.001). There was no significant difference in patients who underwent preoperative laboratory testing, imaging, or referrals. Patients triaged via telemedicine experienced a shorter time to surgery compared to those triaged in person (434 vs 208, = 0.003).
In this cohort, triage by telemedicine allowed otolaryngology patients to have an expedited path to surgery despite having more visits. There is no evidence to suggest that otolaryngologists had an overreliance on diagnostic modalities when triaging by telemedicine.
Among patients undergoing septoplasty, those initially evaluated by telemedicine were more likely to have more preoperative visits and shorter time to surgery than those evaluated in person. Telemedicine can serve as an effective method for triaging surgical patients without excess diagnostics.
由于缺乏完整的体格检查，虚拟问诊的整合受到了包括耳鼻喉科在内的许多外科专业的质疑。因此，有必要分析虚拟问诊或现场问诊患者在检查过程中的差异。
对一组接受鼻中隔成形术的成年人（2021年1月至2022年5月）进行病历审查。通过双样本t检验和卡方检验比较两组（远程医疗组、现场问诊组），以确定术前问诊次数的差异，并评估术前进行实验室检查、影像学检查或转诊的患者的差异。
在338例患者中，225例（66.5%）进行了现场初次评估，113例（33.5%）通过远程医疗进行了初次评估。两组在人口统计学特征上相似（远程医疗组平均年龄39.1岁，现场问诊组平均年龄38.8岁；女性分别为28.9%和37.7%，P = 0.088）。与现场问诊组（2.38次，P = 0.001）相比，远程医疗组的术前问诊次数显著更多（3.03次）。术前进行实验室检查、影像学检查或转诊的患者之间没有显著差异。与现场问诊的患者相比，通过远程医疗分诊的患者手术时间更短（434天对208天，P = 0.003）。
在该队列中，通过远程医疗进行分诊使耳鼻喉科患者尽管问诊次数更多，但仍能更快地接受手术。没有证据表明耳鼻喉科医生在通过远程医疗进行分诊时过度依赖诊断方式。
在接受鼻中隔成形术的患者中，与现场评估的患者相比，最初通过远程医疗评估的患者术前问诊次数更多，但手术时间更短。远程医疗可以作为一种有效的方法，用于对外科患者进行分诊，而无需进行过多的诊断。
