A cohort study of acute plastic surgery trauma and burn referrals using telemedicine

Abstract

A store-and-forward telemedicine system was used to supplement normal telephone referrals to the plastic surgery unit at the Queen Victoria Hospital (QVH). During a 12-week prospective study, 11 units (8 hospitals and 3 minor injury units) with the telemedicine system and 10 units (8 hospitals and 2 minor injury units) without it regularly made referrals (at least 10) to the QVH. There were 389 referrals from the telemedicine-equipped units and 607 telephone referrals from the non-telemedicine units. The telemedicine system was used for 246 of the 389 referrals (63%) made from telemedicine-equipped units. There was a significant difference in the management of patients when the telemedicine system was available, with more patients booked directly into day surgery and fewer attending for assessment. The burns unit and the day surgery unit demonstrated a significantly improved accuracy of triage. Telemedicine could have a valuable role to play in the triage and planning of acute plastic surgery referrals.

Can We Trust the Use of Smartphone Cameras in Clinical Practice? Laypeople Assessment of Their Image Quality

“…6,7 Studies have shown that image-based consultation of remote experts is possible in several specialties like dermatology, plastic surgery, or burn care. [8][9][10][11][12] However, the evidence rests predominantly on studies where photographs were taken with a digital camera, and only a few were conducted using older models of mobile phones. [13][14][15][16][17] Against this background it appears necessary to take a closer look at the quality of pictures taken with smartphone cameras in order to determine the value of incorporating smartphones in medical practice.…”

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

“…Lower resolution systems (mobile phone screens) can result in discordance between face-to-face management and telemedicine assisted referrals (Hsieh et al 2004). We found no discordance for acute burn management (see figure 12) and a 3% discordance for hand injuries at 800 x 600 pixel resolution, see figure 11 (Wallace et al 2007). Compact digital cameras have now surpassed www.intechopen.com…”

“…The Telemedicine group had fewer attendances for clinical review, fewer referrals declined and increased use of day surgery. This significant difference was found in each of the three groups of closed, tidy and untidy injuries with the availability of telemedicine (Wallace et al 2007). Hand injury patients were triaged directly to Day Surgery with significantly greater accuracy, see figure 11.…”

“…These were patients who, on the basis of the referral information, we would anticipate to be treated and discharged home. All of the telemedicine assisted referrals were reviewed and discharged home; whereas 21% of the telephone only referrals could not be safely discharged home and required an unexpected admission (Wallace et al 2007). We also noted a decrease in the proportion of referrals we were unable to accept, as the unit was full, though this did not reach signifcance.…”

“…Its use has increased over the last decade to become a routine part of the care pathway for the management of injured patients, see figure 22. We have published evidence of the change in management of our patients due to the system, with improved triage and efficiency of our acute services (Wallace et al 2007;Wallace et al 2008). Use of the telemedicine system has now become part of routine acute trauma management, see figure 17.…”