Telemedicine in acute plastic surgical trauma and burns

Abstract

T elemedicine is a relatively new development within the UK, but is increasingly useful in many areas of medicine including plastic surgery.1,2 It is widely felt that telemedicine has the potential to improve patient care within health care systems through cost saving and time efficiency in patient care.3 It is already being used with great success in many hospitals in the US and Australia as well as the military service within the UK. DefinitionTelemedicine is the assessment and review of patient information (history, examination or investigations) by health professionals who are separated temporally and/or spatially from their patients (i.e. the practise of medicine from a distance). This interaction is most usually between clinicians but can involve direct clinician-patient contact (e.g. telepsychiatry). 5There are several types classified according to the type of interaction and the information transmitted. Usually, it is divided into two main areas -real-time and store-andforward. Real-time telemedicine is used in videoconferencing and involves synchronous interaction between doctor and patient. Store-and-forward telemedicine involves prior 'storage' of either video or still images, which are then sent to the clinician. This may be at a later time or date. Examples of store-and-forward applications are teledermatology and teleradiology. Telemedicine in acute plastic surgical trauma and burns SM Jones, C Milroy, MA Pickford Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, West Sussex, UKBackground: Telemedicine is a relatively new development within the UK, but is increasingly useful in many areas of medicine including plastic surgery. Plastic surgery centres often work on a hub-and-spoke basis with many district hospitals referring to one tertiary centre. The Queen Victoria Hospital is one such centre receiving calls from more than 28 hospitals in the Southeast of England resulting in approximately 20 referrals a day. Objective: A telemedicine system was developed to improve trauma management. This study was designed to establish whether digital images were sufficiently accurate enough to aid decisionmaking. A store-and-forward telemedicine system was devised and the images of 150 trauma referrals evaluated in terms of injury severity and operative priority by each member of the plastic surgical team. Results: Correlation scores for assessed images were high. Accuracy of 'transmitted image' in comparison to injury on examination scored > 97%. Operative priority scores tended to be higher than injury severity. Conclusions: Telemedicine is an accurate method by which to transfer information on plastic surgical trauma including burns.

Email communication at the medical primary–secondary care interface: a qualitative exploration

“…28 Rural GPs were especially able to benefit patients (relating to timely management and avoiding unnecessary travel over distance) by using email to share digital images with urban secondary care colleagues; this has also been of value in diverse parts of the world. [29][30][31][32][33][34] Differing approaches to the integration and sharing of patient-specific email communication were in evidence, as reported elsewhere. 6 Waldren and colleagues called for such communication to be 'seamlessly interfaced' with EHR software systems to maintain the integrity of the record, avoid potential for transcription errors, and to increase quality of care and patient safety.…”

Current Management of Facial Wounds in UK Accident and Emergency Departments

“…1,3 Telemedicine has been suggested as a tool for facilitating trauma management but has yet to gain widespread popularity. 8 Wound infection rates of up to 7% have been found on review of traumatic injuries. 9 Rates of antibiotic prophylaxis varied for each scenario in this survey: 30% would consider prescribing antibiotics for a dirty wound, 13% for a complex lip wound and only 2% for an extensive forehead wound.…”

The Role of Telemedicine in the Management of Acute Trauma Referrals to a Regional Plastic and Hand Surgery Unit in the South East of England

“…Clinical priority was organised into five groups of immediate, urgent (<6 hours), very soon (<24 hours), soon (<48 hours) and later (>48 hours). The correlation coefficient was 0.78 to 0.81 for grading of the injury and 0.87 to 0.93 for priority of injury (Jones et al 2004). …”

“…Poor image quality can affect a clinician's ability to make a clear diagnosis (Briggs et al 1998;Stutchfield et al 2007); if necessary additional images should always be requested. Our own pilot study (pilot study 1) demonstrated 800 x 600 pixel resolution was adequate for diagnosis and grading of urgency of transfer (Jones et al 2004). This concurs with other telemedicine studies of wound assessment (Wirthlin et al 1998;Murphy et al 2006) and dermatology (Eedy & Wootton 2001;Krupinski et al 2008).…”