As a 4th-year neurosurgery resident, I’ve tried to sink my heels into every aspect of neurosurgical care in order to harness the skills, the knowledge, and the confidence to know that I’ll be ready to provide exceptional care to my own patients at the end of seven years of training. If you asked me before the COVID-19 pandemic, I would have never considered that telehealth and virtual care would not only be launched but depended upon for our outpatient surgical workflow. I had also never imagined that it would soon become an integral part of my medical and surgical education.
Telemedicine has not been a method of health care delivery widely used in surgical subspecialties. As surgeons, we often rely on physical exam and building a relationship with the patient as a major part of our decision to take that patient to the operating room.
As other providers and health care systems are attempting to implement telehealth initiatives and struggling with the same issues, we would like to share our initial experience in hopes we can all provide quality, compassionate care to our patients across the globe. Here are some of the most important highlights of issues we have encountered.
- A computer, tablet, or phone with video capability as well as reliable internet access is needed. This can be a challenge for some patients, particularly the elderly, and arranging the visit through a family member is sometimes necessary.
- Depending on the platform (EPIC, WebEx, Zoom, Doximity) used to conduct the visit, there can be unanticipated sign-up, sign in, and technology issues. Consider setting up a backup platform option, or just be prepared to make a phone call to the patient instead.
- Sometimes patients don’t understand what a virtual visit is, and they show up at clinic. When the appointment is changed or scheduled, it is vital that this is communicated directly with the patient and instructions explicitly explained.
- Video quality is not good enough to evaluate incisions, so instructing patients to send photos prior to the visit via secure email or your institution’s version of My Chart to supplement post-operative visits is helpful.
- Having a resident, nurse practitioner, or scribe accompany the visit either jointly through the video platform or via speakerphone on a separate call is helpful since they can document the visit and place orders while the provider conducting the visit can be fully attentive to the patient.
- For patients who primarily speak a different language, it is important to coordinate with an interpreter prior to the appointment so they can help conduct the visit jointly through the video platform or via speakerphone on a separate call.
- Nurse practitioners, nurse coordinators, and schedulers are the real MVPs in successful telehealth implementation, as they coordinate the appointments, coach the patients on how to sign up/log in, facilitate imaging uploading, and navigate their care. As difficult and frustrating as this process sometimes feels as a surgeon, we know the whole team is working diligently to make it happen.
One of the most important challenges of utilizing telemedicine methods is determining what patient populations with specific pathology are suitable for video and phone visits. This is an ongoing initiative that we are still working to improve upon.
As a resident in neurosurgical training, even though this platform for health care is an unexpected one, I am grateful for an unprecedented opportunity to explore a new territory of health care delivery in neurosurgery, and I am confident that I’ll be able to implement this in my practice in the future. Regardless of some of the issues we have faced early on, we are working on methods of improving this process, and we hope to make this a successful method of providing compassionate, quality, and efficient care in order to maximize our ability to serve more of our patients in the future long after the COVID-19 pandemic has passed.
Randaline Barnett is a neurosurgery resident. Carolyn Quinsey is a neurosurgeon.
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