Summary
Visual images can enhance communication over a distance. In the UK, plastic surgery
provides services over large distances by a ‘hub and spoke’ model. Telemedicine could
help to increase the efficiency of service for plastic surgery patients. Telemedicine,
along with the impending Electronic Patient Record system could combine to improve
communication, patient triage, record keeping, audit and could lead to a better quality
of clinical care. Another benefit could be significant cost savings.
We report our experience of the introduction of telemedicine to a Regional Plastic
Surgery Service. Our first study compared assessments from images and patient examinations,
which gave us confidence in the use of images [Jones SM, Milroy C, Pickford MA. Telemedicine
in acute plastic surgical trauma and burns. Ann R Coll Surg Engl 2004;86:239–42]. We proceeded to a 10-week evaluation of all 973 referrals to our unit. We
found that the system was used for a wide variety of injuries and for 42% of the 452
patients where the system was available. Initial resistance was overcome by the ease
of use of the system, with both receiving and referring clinicians reporting benefits.
The third phase was a 12-week prospective cohort study of 996 patients comparing the
referrals with and without the telemedicine system. The system was available for 389
patients, and used for 243 patients (63%). The groups were analysed by a chi squared
test and confidence interval calculation. We demonstrated a significant difference
in the initial management of patients, with 10% more being booked directly to our
Day Surgery Unit. There was a decrease in number of occasions when we were unable
to accept a patient due to a lack of capacity. We found no change in the patients
being managed with telephone only advice.
We found that telemedicine is a valuable method of providing useful preliminary information
in the referral process for injured patients and often significantly modifies their
treatment and/or management plan. This has implications for the use of Information
Technology resources and potentially the delivery of healthcare in relation to the
management of injured patients.
Keywords
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Article info
Publication history
Published online: March 13, 2007
Accepted:
March 17,
2006
Received:
December 20,
2005
Identification
Copyright
© 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
