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Telemedicine in Neurosurgery: Lessons Learned and Transformation of Care During the COVID-19 Pandemic.

ABSTRACT: BACKGROUND:Before the COVID-19 pandemic, telemedicine utilization was mostly used for postoperative visits only in neurosurgery. Shelter-in-place measures led the rapid expansion of telemedicine to address the needs of the neurosurgical patient population. Our goal is to determine the extent of adoption of telemedicine across tumor, vascular, spine, and function neurosurgery and utilization for new patient visits. METHODS:A single-center retrospective cohort study of patients who received neurosurgical care at a tertiary academic center from February to April 2020 was conducted. Patients evaluated from March to April 2019 were included for comparison. A total of 10,746 patients were included: 1247 patients underwent surgery, 8742 were seen in clinic via an in-person outpatient visit, and 757 were assessed via telemedicine during the study period. RESULTS:A 40-fold increase in the use of telemedicine was noted after the shelter-in-place measures were initiated with a significant increase in the mean number of patients evaluated via telemedicine per week across all divisions of neurosurgery (4.5 ± 0.9 to 180.4 ± 13.9, P < 0.001). The majority of telemedicine appointments were established patient visits (61.2%), but the proportion of new patient visits also significantly increased to an average of 8.2 ± 5.3 per week across all divisions. CONCLUSIONS:Use of telemedicine drastically increased across all 4 divisions within neurosurgery with a significant increase in online-first encounters in order to meet the needs of our patients once the shelter-in-place measures were implemented. We provide a detailed account of the lessons learned and discuss the anticipated role of telemedicine in surgical practices once the shelter-in-place measures are lifted.

SUBMITTER: Mouchtouris N

PROVIDER: S-EPMC7274123 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Telemedicine in Neurosurgery: Lessons Learned and Transformation of Care During the COVID-19 Pandemic.

Mouchtouris Nikolaos N Lavergne Pascal P Montenegro Thiago S TS Gonzalez Glenn G Baldassari Michael M Sharan Ashwini A Jabbour Pascal P Harrop James J Rosenwasser Robert R Evans James J JJ

World neurosurgery 20200605

<h4>Background</h4>Before the COVID-19 pandemic, telemedicine utilization was mostly used for postoperative visits only in neurosurgery. Shelter-in-place measures led the rapid expansion of telemedicine to address the needs of the neurosurgical patient population. Our goal is to determine the extent of adoption of telemedicine across tumor, vascular, spine, and function neurosurgery and utilization for new patient visits.<h4>Methods</h4>A single-center retrospective cohort study of patients who ...[more]

PMID: 32512241

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Project description:ObjectiveTo 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 methodsIn 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.ResultsIn 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.ConclusionRapid 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.

Dataset Information

Telemedicine in Neurosurgery: Lessons Learned and Transformation of Care During the COVID-19 Pandemic.

Publications

Telemedicine in Neurosurgery: Lessons Learned and Transformation of Care During the COVID-19 Pandemic.

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