Telemedicine Utilization in Neurosurgery During the COVID-19 Pandemic: A Glimpse Into the Future?

Abstract

Objective: To describe telemedicine utilization in neurosurgery at a single tertiary institution to provide outpatient care during the coronavirus disease 2019 (COVID-19) pandemic, with 315 telemedicine visits performed by the neurosurgery department. Patients and Methods: In response to the COVID-19 pandemic national stay-at-home orders and postponed elective surgeries, we converted upcoming clinic visits into telemedicine visits and rescheduled other patients thought not to be markedly affected by surgical postponement. We reviewed the charts of all patients who had telehealth visits from April 1 through April 30, 2020, and collected demographic information, diagnosis, type of visit, and whether they received surgery; a satisfaction questionnaire was also administered. Results: In March 2020, 94% (644 of 685) of the neurosurgery clinic visits were face-to-face, whereas in April 2020, 55% (315 of 573) of the visits were telemedicine (P<.001). In April, of the 315 telemedicine visits, 172 (55%) were phone consults and 143 (45%) video consults; 101 (32%) were new consults, 195 (62%) return visits, and 18 (6%) postoperative follow-up. New consults were more likely to be video with audio than return visits and postoperative follow-up (P<.001). Only 39 patients (12%) required surgery. Ninety-one percent of the questionnaire respondents were very likely to recommend telemedicine. Conclusion: Rapid implementation of telemedicine to evaluate neurosurgery patients became an effective tool for preoperative consultation, postoperative and follow-up visits during the COVID-19 pandemic, and decreased risks of exposure to severe acute respiratory syndrome coronavirus 2 to patients and health care staff. Future larger studies should investigate the cost-effectiveness of telemedicine used to triage surgical from nonsurgical patients, potential cost-savings from reducing travel burdens and lost work time, improved access, reduced wait times, and impact on patient satisfaction.

Patient-Level Factors Associated with Utilization of Telemedicine Services from a Free Clinic During COVID-19

“…In contrast, other care settings may see an even mix of audio-only and video telemedicine encounters. 41 Although underserved populations tend to have less access to internet and smartphones, 42,43 there is a gradual increase in smartphone ownership among these populations. 44 Our study team found that over 90% of patients seen at our free clinics self-reported smartphone ownership, 45 suggesting many patients seen should have had video capabilities on their smartphones.…”

Current and future use of telemedicine in surgical clinics during and beyond COVID-19: A narrative review

“…Nonetheless, the advantages of telemedicine are met with several limitations. Most notably, there has been little change to concerns of clinical barriers for complex patients who need examination or complex interaction [ 18 , 23 , 36 , 64 ]. “Unreliability” concerns with patients down-grading signs and symptoms via telephone consultation [ 56 ] remains a challenge as consultation via telephone is a popular mode of telemedicine used by clinician and patient, which may be improved with increased video-conferencing use.…”

Telehealth Sustainability in a Neurosurgery Department During the COVID-19 Pandemic

“… 7 Some have proposed that it may be here to stay in the future and were more hopeful in implementing it. 8 Viable long-term integration of TH will most likely involve the dedication of resources for the training of both providers and patients to reach its full potential. 19 …”

“…Many institutions had rapidly adopted TH since the emergence of the pandemic 1 ; however, its use in neurosurgery had not been widely reported until the pandemic. 7 , 8 Understanding the benefits and challenges of using TH in a university hospital setting can provide other institutions with a practical view of whether or not to implement it.…”