Doctor-patient distancing: an early experience of telemedicine for postoperative neurosurgical care in the time of COVID-19

Abstract

Background Telemedicine remains an important tool of healthcare services delivery especially in the era of the COVID-19 pandemic. Its advantages include saving the time and money of the patients and the prevention of infection among healthcare providers. Objectives In this study, we aim to evaluate the effectiveness and safety of telemedicine visits in providing postoperative care of neurosurgical patients. Materials and methods We conducted this prospective study on 30 neurosurgical patients who were evaluated after surgery via telemedicine visits for 30 days. During the virtual visits, we discussed the clinical progress of patients, wound status, treatment modification, the time of return to work, postoperative complications, and the radiological data of the patients. All the patients were given an emergency number to call in case of urgent issues. The satisfaction of patients and doctors was measured with the aid of two questionnaires. Results The patients’ age ranged from 18 to 65 years. Twenty patients were male and 10 patients were female. We performed 20 cranial operations and 10 spinal operations. Most patients needed more than 4 h to reach the hospital. The total number of telemedicine visits was 67 visits. We received about 62 emergency calls. Pain management, seizures control, wound infection, and hydrocephalus is among issues that were evaluated and managed via telemedicine visits. The overall satisfaction rate among patients and doctors was 90% and 95%, respectively. Conclusion Virtual outpatient clinics seem to be a safe and effective way of postoperative care especially in the time of the COVID-19 pandemic.

<p>Patient Satisfaction and Associated Factors During COVID-19 Pandemic in North Shoa Health Care Facilities</p>

“…21,22 Telemedicine also increases healthcare coverage through emails, telephone, and video calls to minimize patient travel to healthcare facilities, time-saving, and cost-effective with increased patient satisfaction. [23][24][25] The Ethiopian Federal Ministry of Health implemented Compassionate Respectful Care (CRC) as one of the healthcare sector transformation plan to increase client satisfaction and health service quality. 26 However, the satisfaction of chronic patients and quality of service is currently affected by the COVID-19 pandemic, imposing a shortage of medical supplies and uncertainness of being infected due to limited global movement from one country to another.…”

Telemedicine in neurosurgery during SARS-CoV2 Pandemic

“…[22] Blue et al described following limitations of telemedicine examination: difficulties in corneal reflex and visual fields assesment, neuromuscular pathologies: difficulties in examination of tone, rigidity, peripheral strength, subtle signs of Parkinson's disease -rigiditiy, retropulsion pull testing; impossible to perform HINTs exam for vestibular syndrome and Dix-Hallpike for cerebellar examination. [13] Neurooncology is challenged with neuro-cognitive and linguistic deficits, which results in more difficult communication with the patients, with increased difficulty during the remote consultation [15] In spinal surgery it was noted by several authors that virtual spinal examination can miss the subtle neurologic deficits, only possible to examine and assess during face-to-face consultation [11;14] Additionally, it was mentioned that in order to limit the non-necessary emergency calls, the checklist of warning symptoms should be prepared and provided for patients, who can assess the necessity of emergency call themselves with the help of the checklist [9] Speaking of ethical concerns, the main concern is related to the risk of disclosure of the sensitive data and violation of patient's privacy. [9] Depending on the countries technical resources, the virtual clinics have been conducted via hospital encrypted platforms, such as BlueJeans or MyChart, or the regular, non-encrypted messengers, like Facebook Messenger or Zoom.…”

“…[13] Neurooncology is challenged with neuro-cognitive and linguistic deficits, which results in more difficult communication with the patients, with increased difficulty during the remote consultation [15] In spinal surgery it was noted by several authors that virtual spinal examination can miss the subtle neurologic deficits, only possible to examine and assess during face-to-face consultation [11;14] Additionally, it was mentioned that in order to limit the non-necessary emergency calls, the checklist of warning symptoms should be prepared and provided for patients, who can assess the necessity of emergency call themselves with the help of the checklist [9] Speaking of ethical concerns, the main concern is related to the risk of disclosure of the sensitive data and violation of patient's privacy. [9] Depending on the countries technical resources, the virtual clinics have been conducted via hospital encrypted platforms, such as BlueJeans or MyChart, or the regular, non-encrypted messengers, like Facebook Messenger or Zoom. In the beginnings of the telemedicine in 1977 the diagnosis and recommendations were not disclosed until the in-person meeting, however, in recent situation it is important to forward the diagnosis or opinion as soon as possible, as the schedule of in-person consultation is hard to define.…”

“…[17;19] Ethical issues depend also on cultural differences, in various cultures female patients refuse telemedicine consultations also due to the lack of trust in privacy protection. [9] If the usage of telemedicine is incorporated in future health care, the important aspect should include patient's wishes and needs while offering this form of consultation, leaving the final choice of the mean of communication to the patient.…”

“…Only 6% of patients required an emergency visit in the hospital after making the emergency call. [9] Study from USA by Mouchtouris et al highlighted the differences between the application of telemedicine before and after the beginning of COVID pandemic. The Department observed over 40-fold increase of telemedicine usage (50 in 2019 to 707 in 2020) with home office devices and software, which enabled physicians to view the hospital records remotely from home environment, as well as videoconferences with the patients and nursing staff.…”