Tele-Plastic Surgery: The answer to providing underserved populations with specialist expertise for the management of acute soft tissue injuries and hand injuries, and the limitations to deployment
Mark Granick
Rutgers New Jersey Medical School
Mark S. Granick, M.D., F.A.C.S. is Professor of Surgery, tenured, and Chief of Plastic Surgery at Rutgers New Jersey Medical School. Dr. Granick has a 30 year history of academic plastic surgical experience. He trained at Cornell University (BA) and Harvard Medical School (MD). His residency training was performed at Harvard and at the University of Pittsburgh, and he is board certified in plastic surgery. Dr. Granick is very active on the international academic scene. He has edited 8 textbooks, written 50+ book chapters and 200 peer reviewed scholarly publications. He founded and co-edits the first open access, Pub Med indexed plastic surgery journal, ePlasty. His research interests include wound technology, biofilm, and telemedicine. He is anxious to apply the latest telemedical technology to assist people with acute injuries in remote areas.
Abstract
Introduction Approximately 20% of all Emergency Department (ED) visits are for injuries treated by plastic surgeons. Many communities have a deficient specialty workforce. We propose telemedicine as a solution. Methods In... [ view full abstract ]
Introduction
Approximately 20% of all Emergency Department (ED) visits are for injuries treated by plastic surgeons. Many communities have a deficient specialty workforce. We propose telemedicine as a solution.
Methods
In order to examine the efficacy of telemedicine three experiments were performed: a store and forward digital image assessment of 100 patients; a four month review of 78 plastic surgical emergency consultations; and a one month real time remote iPad driven digital image assessment of 42 emergencies. A literature review was performed.
Results
Digital image assessment was accurate and image quality did not matter. All reviewed consultations were appropriate and required specialist expertise. Numerous non-consulted patients suffered incorrect treatment. Real time remote plastic surgeons were 17 times faster (p<.001) and just as accurate. Four treatment errors were detected.
Conclusions
These studies demonstrate that both delayed and real time digital image assessment are accurate in emergency settings regardless of the image quality. Complex injuries require specialist care. By utilizing an app designed to provide immediate plastic surgery feedback to emergency physicians, the consultation is 17 times more efficient and has the potential to minimize initial treatment errors by non-specialists. Telemedicine has potential application to the QA/QI process. In addition, emergency tele-plastic surgical evaluations can potentially prevent over-treatment of patients in the ED by on-site plastic surgeons. The primary impediment to wide spread utilization of proven telemedical interventions is that the legal structure is lagging far behind the developing technologies. It is imperative that Washington lawmakers create comprehensive legislation that allows telemedicine to develop in a controlled and regulated fashion. Telemedicine, as applied to plastic surgery, has an enormous potential to provide under-served populations with specialized care, to act as a QA/AI tool, to prevent medical errors, and to prevent over-treatment in Emergency departments.
Authors
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Mark Granick
(Rutgers New Jersey Medical School)
Topic Area
Areas of concurrent underuse and overuse
Session
PS-1 » Posters (concurrent w/ Lunch) (12:30 - Friday, 5th May, Rear of Salons 4 & 5)
Presentation Files
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