A Surgical Telemedicine Clinic in a Correctional Setting

Abstract

The telemedicine network between Virginia Commonwealth University Health System (VCUHS) and the Department of Corrections in Virginia has seen a steady increase in the number of disciplines involved in consultation. Hardware integration and methodologies between VCUHS and correctional facilities were supported by Polycom videoconferencing technology. During consults, a VCUHS-based surgeon was provided with patient records, picture archiving and communication system images, and laboratory data or text reports sent by fax. A registered nurse at the correctional site assisted the surgeon at VCUHS. Electronic stethoscope and dermascope were also used for physical examination of inmates. Preoperative encounters included physical examination and informed consent from video. Electronic scheduling and preoperative orders were issued at the time of consultation. Of the 55 consultations completed this past year, 27 were followed by surgical procedures. In one case, the referral diagnosis was corrected and one case required minor change in diagnosis at an in-person examination on the day of surgery. Twenty patients had postoperative examination by telemedicine, and five of these required a second follow-up telemedicine visit. All patients confirmed their informed consent and acknowledged their surgeon upon first meeting face to face at the hospital. Telemedicine consultation for general surgery is an effective asset and can limit patient transfer.

Telehealth: Increasing Access to High Quality Care by Expanding the Role of Technology in Correctional Medicine

“…Encryption software, high-definition cameras, monitors, and equipment used to perform physical exams, such as electronic stethoscopes, otoscopes and ophthalmoscopes, are widely available and generally affordable. In practice, synchronous telemedicine has very few clinical limitations, and several studies in the prison population have reported successful outcomes when using telemedicine for psychiatric management [ 29 , 30 ], surgical services [ 31 ] and emergency medicine [ 32 ], with enhanced, timelier access to care, cost savings and high patient satisfaction [ 33 ]. In addition, the use of telemedicine for subspecialty, multidisciplinary care of prisoners with HIV has been shown to result in a greater virologic suppression and rise in CD4+ T-lymphocyte counts [ 34 ], and improved laboratory markers associated with morbidity, mortality and transmission [ 35 , 36 , 37 , 38 ], and to enhance the coordination of care between services for people living with HIV (PLWH) [ 39 ].…”

Telesurgery in medical school and teaching hospital

“…The telesurgery promoted surgeon access, low cost and quality care through the use of videoconferencing and recording of data, replacing the conventional transport patients for pre and post-operative consultations. Thus, the researchers concluded that telemedicine is effective in health care in this specific group of patients 19 .…”

Improving care quality with prison telemedicine: The effects of context and multiplicity on successful implementation and use

“…The quantitative outcomes data reported varied from correlation between in-person/telemedicine assessment scores, 38 numbers of consultations, 39–42 patient satisfaction scores, 43 cost effectiveness, 34,44–50 and clinical outcome measures. 51–52 Very few studies reported outright failures of telemedicine, 53–54 with most finding it offered equivalent or improved care quality 5,42,43,51,52,55–70 at an acceptable cost.…”