title: Plastic surgery telehealth consultation expedites Emergency Department treatment.
abstract: 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.
authors.affiliation: 1 Brown University, Alpert Medical School, Providence, RI; Department of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Angie M
authors.initials: AM
authors.lastname: Paik
authors.affiliation: 2 Department of Surgery, Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Granick
authors.affiliation: 3 Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Scott
mesh_terms: D034201:Computers, Handheld; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005151:Facial Injuries / Q000601:surgery; D006230:Hand Injuries / Q000601:surgery; D006801:Humans; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D019114:Remote Consultation / Q000379:methods*; D013518:Surgery, Plastic / Q000379:methods; D013997:Time Factors; D014947:Wounds and Injuries / Q000601:surgery
keywords: Emergency Consultation; Quality Assurance/Quality Improvement (QA/QI); Telehealth; Telemedicine; plastic surgery