Telemedicine After Upper Extremity Surgery: A Prospective Study of Program Implementation

Abstract

Purpose: Our purpose was to evaluate the implementation of a postoperative hand and upper extremity telemedicine program. We aimed to compare travel burden, visit time, and patient satisfaction between an initial postoperative telemedicine visit and a second conventional in-clinic visit.

Methods: Telemedicine guidelines established by our hospital system were used as inclusion criteria for this prospective study, which included patients indicated for surgery in the outpatient clinic during a 3-month period. Patients were excluded if they had wounds closed with nonabsorbable suture, remained admitted to the hospital, or required a custom orthosis at their first postoperative visit. Baseline demographics and patient-reported outcome measures were collected prior to surgery. Information pertaining to technology usage was collected for the telemedicine visit and travel information was obtained for the in-clinic visit. Patient satisfaction was recorded for both visits.

Results: Fifty-seven of 87 patients (66%) who met the inclusion criteria elected to participate in the study. A cell phone was utilized by 89% of patients and 88% of visits were performed from the patient's home. There were 4 technological complications during the study period (7%). Mean round-trip travel distance for the in-clinic visit was 60 miles with an average drive time of 85 minutes. Visit times were significantly shorter with telemedicine (7 minutes vs 38 minutes). Telemedicine was preferred by 90% of patients for subsequent encounters. All 4 clinical complications were recognized during the telemedicine visit.

Conclusions: A telemedicine program for postoperative care after hand and upper extremity surgery decreases travel burdens associated with conventional in-clinic appointments. Telemedicine significantly decreases visit times without decreasing patient satisfaction for patients who elect to participate in remote video visits. The ability to recognize early postsurgical complications was not compromised by utilizing this technology, even during our early experience.

Clinical relevance: Telemedicine after hand and upper extremity surgery results in high levels of patient satisfaction and decreases visit times and the travel burdens associated with conventional in-clinic appointments.

Keywords: Hand surgery; technology; telehealth; telemedicine; virtual visits.