A pilot study of telemedicine for post-operative urological care in children

Abstract

We conducted a retrospective study of paediatric urological surgery patients over a 12-month period. We compared patients followed up by telemedicine with those who had post-operative follow-up on site at the Arkansas Children's Hospital (ACH) in Little Rock. All pre-operative patients living in northwest Arkansas were given the opportunity to use telemedicine from a satellite clinic at Lowell, 328 km from the hospital. Of 61 patients, 10 chose telemedicine and 51 chose to be evaluated at the ACH clinic. All telemedicine visits were completed successfully, but in four cases, the video clarity of the telemedicine images was not sufficient for decision-making, and a digital photograph was sent by email to the physician at the ACH. There were no post-operative surgical complications in either patient group. In the telemedicine group, the median distance to the ACH was 330 km, and the median distance to the remote clinic was 35 km. In the on-site group, the median distance to the ACH was 293 km, which was significantly less (P=0.03). In the on-site group, the median travel time to the ACH was 174 min. If the telemedicine group had driven to the hospital, the median travel time would have been 192 min. Logistic regression showed that for every 37 km increase in distance to ACH, patients had a 111% increase in the odds of receiving telemedicine compared to receiving on-site care (OR=2.1, 95% CI: 1.0, 4.4). The pilot study supports the use of telemedicine for the post-operative evaluation of paediatric urology surgery patients and suggests that substantial travel distance and time savings can be made.

Current Use of Telemedicine for Post-Discharge Surgical Care: A Systematic Review

“…56,57 Seven studies examined the potential for replacing follow-up clinic visits with a telephone call 47,54 or an online videoconference, either from the patient’s home 45,48,49 or from an affiliated remote clinic site. 50,52,53 Among the studies using telemedicine for ongoing monitoring, patients’ reported symptoms were collected either by automated telephone survey 43 or videophone with live patient interviews. 51 Specific objective clinical data were collected using text messages for daily surgical drain output, 55 electronic transmission of home spirometry results, 58 and more complex multi-modal monitoring of symptoms, blood pressure, and medication adherence.…”

Improving access to urologists through an electronic consultation service

“…8 Urological telemedicine has been studied in a small number of pediatric populations and has been found to provide better continuity of care by eliminating distance barriers and reducing the burden on families travelling to bring their children to more traditional appointments. 9,10 Studies in the adult population have so far been mainly limited to the application of remote telesurgery, with the advent of robotic surgical systems. 11,12 Some small, single-centre studies of the adult urological population and telemedicine in the U.S. have so far shown good patient/provider satisfaction and success.…”

Telemedicine in Surgery: What are the Opportunities and Hurdles to Realising the Potential?

“…As mentioned above, one of the main areas in which teleconsultation in surgery has been highly effective is the provision of pre-and postoperative care especially to rural or isolated patients. Canon et al demonstrated its feasibility even in a paediatric population following urological surgery [42]. Particularly in subspecialist areas, patients often have to travel long distances to see the surgical teams imposing a significant burden.…”

“…Particularly in subspecialist areas, patients often have to travel long distances to see the surgical teams imposing a significant burden. Through their teleservice, Canon et al were able to save families an average of $88 and 2.6 h per consultation [42]. Like the email systems, other more lowtechnique systems have also been developed such as a mobile Bapp^which took over from a telephone-based follow-up service for ambulatory plastic surgery patients [43].…”