TeleNeurosurgery: The Use of a Telemedicine Program to Improve Interfacility Communication and Aid in Triage of Patients with High-Grade Intracerebral Hemorrhage. (16th November 2020)

• Record Type: Journal Article
• Authors: Wright, James; Gerges, Christina; Shammassian, Berje H; Zhou, Xiaofei; Wright, Christina; Duan, Yifei; Rosenfeld, Kenneth; D'Anza, Brian; Pronovost, Peter; Sajatovic, Martha; Bambakidis, Nicholas C
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_476
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Over the past several years there has been a dramatic increase in the implementation of telemedicine technology to aid in the delivery of care across community, inpatient, and emergency settings. This technology has proved valuable for acute life-threatening clinical scenarios, such as acute ischemic stroke and the administration of tissue plasminogen activator. A novel neurosurgical telemedicine program was implemented within an academic tertiary care center to assist in consultation of patients with high-grade intracranial hemorrhage (ICH), defined as ICH score greater than or equal to 4. METHODS: This was a prospective evaluation of feasibility of implementation of a TeleNeurosurgery program within a large healthcare system for the management and triage of patients with high-grade ICH. Transfer center consultations for adult patients with high-grade ICH or preexisting DNR/DNI orders with an admitting diagnosis of ICH automatically triggered a TeleNeurosurgery Consultation. Telemedicine consultations were performed by a neurocritical care trained PGY-6 or PGY-7 neurosurgical resident and included the participating community practice physician, as well as the patient's family members or decision makers RESULTS: Over the 18-month study period a total of 14 patients were enrolled and 8 screen failures were identified. This pilot study was successful, with enrollment of 63.6% (n = 14/22) of patients who met criteria. All patients who participated in TeleNeurosurgery consultation remained at the presenting facility for end-of-life care and palliative medicine consultation. Both community emergency physicians and consulting subspecialists reported satisfaction with the TeleNeurosurgery consultation process and a perceived benefit to patients, families, and emergency physicians CONCLUSION: The program proved feasible and several areas in need of improvement within the health system were identified. Emergency physicians reported comfort with the process, program effectiveness, and improved access to care by implementation of this program. Expansion of this infrastructure to include other emergent clinical conditions that would benefit from immediate neurosurgical consultation is feasible. Future studies to evaluate family and patient-centered outcomes are warranted.