A Retrospective Analysis of Patients Undergoing Telemedicine Evaluation in the PreAnesthesia Testing Clinic at H. Lee Moffitt Cancer Center

Translating Value Across Telehealth Stakeholders: A Rapid Review of Telehealth Measurement Evidence and a New Policy Framework to Guide Telehealth Researchers

Introduction: The surge in virtual care during the pandemic was accompanied by an increase in telehealth data of interest to policy stakeholders and other health care decision makers. However, these data often require substantial preprocessing and targeted analyses to be usable. By deliberately evaluating telehealth services with stakeholder perspectives in mind, telehealth researchers can more effectively inform clinical and policy decision making. Objective: To examine existing literature on telehealth measurement and evaluation and develop a new policy-oriented framework to guide telehealth researchers. Materials and Methods: A systematic rapid review of literature on telehealth measurement and evaluation was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The findings were analyzed and applied to the Supporting Pediatric Research on Outcomes and Utilization of Telehealth Evaluation and Measurement (STEM) Framework through the lens of key health care delivery decision makers to create a STEM Policy Framework Results: An initial search yielded 2,324 peer-reviewed articles and gray literatyre from 2012 to 2022, of which 56 met inclusion criteria. These measured and evaluated telehealth access (41.5%), quality (32.1%), cost (15.1%), experience (5.7%), and utilization (5.7%), consistent with the STEM Framework domains, but there was no universal approach. The STEM Policy Framework focuses this literature by describing data measures for each domain from the perspectives of five stakeholders. Conclusions: Literature describing measurement and evaluation approaches for telehealth is limited and not standardized, with few considering policy stakeholder perspectives. With this proposed STEM Policy Framework, we aim to improve this body of literature and support researchers seeking to inform telehealth policy through their work.

Improvement in Adherance to Anesthesia Preoperative Appointment With Telemedicine: A Retrospective Analysis

BACKGROUND

Amidst the coronavirus disease 2019 (COVID-19) pandemic, the sudden demand for virtual medical visits drove the expansion of telemedicine across all medical specialties. Current literature demonstrates limited knowledge of the impact of telehealth on appointment adherence, particularly in preoperative anesthesia evaluations. This study aims to describe the impact of telemedicine-based anesthesia evaluation and its effects on appointment completion.  Methods: This was a retrospective, non-randomized, cohort study of adult patients at the University of California, Los Angeles, United States, who received preoperative anesthesia evaluations by telemedicine or in-person in an academic medical center. From January to September 2021, we evaluated telemedicine and in-person appointment completion in patients scheduled for surgery. The primary outcome was the incidence of appointment completion. The secondary outcomes included appointment no-shows and cancellations.  Results: Of 1332 patients included in this study, 956 patients received telehealth visits while 376 patients received in-person preoperative anesthesia evaluations. Compared to the in-person group, the telemedicine group had more appointment completions (81.38% vs 76.60%), fewer cancellations (12.55% vs 19.41%), and no statistical difference in appointment no-shows (6.07% vs 3.99%). Compared to the in-person group, patients who received telemedicine evaluations were younger (55.81 ± 18.38 vs 65.97 ± 15.19), less likely Native American and Alaska Native (0.31% vs 1.60%), more likely of Hispanic or Latino ethnicity (16.63% vs 12.23%), required less interpreter services (4.18% vs 9.31%), had more private insurance coverage (53.45% vs 37.50%) and less Medicare coverage (37.03% vs 50.53%).

CONCLUSIONS

This study demonstrates that telemedicine can improve preoperative anesthesia appointment completion and decrease appointment cancellations. We also demonstrate potential shortcomings of telemedicine in serving patients who are older, require interpreter services, or are non-privately insured. These inequities highlight potential avenues to increase equity and access to telemedicine.

Assessment of Knowledge and Attitude of Anaesthetists in Utilizing Telehealth-Based Pre-anaesthesia Evaluation

BACKGROUND

This study aims to assess anaesthesiologists' understanding and attitudes toward utilizing telehealth for pre-anaesthesia evaluations (PAEs) in instances where a scheduled surgery is deferred to the procedure day due to hospital or patient-related reasons.

METHODOLOGY

This observational cross-sectional study involved anaesthesiologists with over six months of hospital experience, opting to participate voluntarily. Non-probability sampling was employed for participant selection. The study's objectives were communicated, and consent was obtained. Data were recorded in Microsoft Excel and analyzed using STATA 12.0.

RESULTS

Of the 237 participating anaesthetists, 155 were aged 21 to 40. Notably, 88.6% (n=210) expressed interest in advanced telemedicine learning, and 77.6% (n=184) were keen on its implementation. Common sources of information included tele-diagnosis (n=194), tele-education, counselling (n=147), and tele-surveillance, with additional input from telesurgery, tele-triage, tele-monitoring, and teleradiology.

CONCLUSION

The study highlights anaesthetists' strong enthusiasm for adopting advanced telemedicine and teleconferencing. Predominant information sources included tele-diagnosis, tele-education, tele-counselling, and tele-surveillance. The majority endorsed the potential of telemedicine to aid patients, expressing comfort in using it for pre-anaesthesia examinations.

[Teleconsultation for preoperative evaluation and informed consent-Are we ready for a paradigm shift?]

In Germany, approximately 17 million anaesthesiological procedures and, consequently, roughly the same number of preoperative consultations are conducted each year. So far, these have predominantly taken place in person. However, recent developments in technology, medical-legal aspects, and politics, combined with the catalyzing effect of the pandemic situation, have led to a significant boost in telemedicine. In the field of anaesthesia, there are new approaches to implementing telemedicine in the pre- and postoperative setting. This article focuses on the preoperative setting and presents general requirements for a teleconsultation as preoperative evaluation, the current state of technology, and medical-legal aspects.

A Feasibility Study on a Telemedicine Hybrid Protocol for Preoperative Anesthetic Assessment

Background Over the past decade, telemedicine has experienced significant growth due to technological advancement, and the coronavirus disease 2019 (COVID-19) pandemic further accelerated its adoption. However, the field of anesthesiology has been slow in integrating and embracing telemedicine compared to other medical specialties. Methods We conducted an observational pilot feasibility study at a tertiary hospital in Singapore to assess the viability of a telemedicine hybrid protocol for preoperative anesthetic assessment. The study included patients aged 21 to 65 years, classified as American Society of Anesthesiology (ASA) physical status class 1 or 2, with a body mass index (BMI) below 35 kg/m², who were capable of managing video conferencing. The patients selected were scheduled for low-risk surgeries. The primary objective was to evaluate the medical and technical feasibility of our telemedicine hybrid protocol, while the secondary objectives included assessing patient satisfaction and obtaining feedback from relevant stakeholders. Results From November 2021 to April 2022, a total of 116 patients were recruited, with 96 patients completing the study. No technical difficulties, surgical case cancellations, or incidents of unanticipated difficult airways were reported. The majority of survey respondents (88%) expressed satisfaction with the video consultation and indicated a preference for it over physical consultations for future preoperative anesthesia evaluations. Conclusion Based on our findings, a telemedicine hybrid protocol for preoperative anesthetic assessment demonstrated both technical and medical feasibility while yielding high patient satisfaction. Future research could focus on expanding the protocol to encompass more complex surgeries and include patients with higher ASA status.

Modern preoperative evaluation in ambulatory surgery - who, where and how?

PURPOSE OF REVIEW

Ambulatory surgery is increasingly performed in medically complex patients. This dynamic environment requires new approaches to ensure cost-effective, efficient, and ultimately safe preoperative evaluation of the patient. This review investigates recent advances in the assessment of ambulatory patients, with a special focus on patient screening, digital communication, and multidisciplinary team evaluation.

RECENT FINDINGS

Identifying suitable candidates for ambulatory surgery relies on a variety of medical, surgical, and institutional factors. Identification of high-risk patients and optimization of their treatment can be achieved through multidisciplinary protocols specific to the local institution and in line with current guidelines. Virtual assessment may be sufficient for most patients and provide an efficient evaluation strategy and high patient satisfaction. Prescreening can be supported by preoperative nursing teams.

SUMMARY

The increasing complexity of treatment provided in day surgery offers a unique opportunity to highlight the importance of anesthesiology staff as perioperative caregivers. Preoperative evaluation serves as a central junction to integrate a variety of surgical, medical, and institutional factors to provide safe, satisfactory, and efficient care for patients. Implementing technological innovation to streamline and facilitate this process is paramount.

Mobile internet-based mixed-reality interactive telecollaboration system for neurosurgical procedures: technical feasibility and clinical implementation

OBJECTIVE

To increase access to health interventions and healthcare services for patients in resource-constrained settings, strategies such as telemedicine must be implemented for the allocation of medical resources across geographic boundaries. Telecollaboration is the dominant form of surgical telemedicine. In this study, the authors report and evaluate a novel mobile internet-based mixed-reality interactive telecollaboration (MIMIT) system as a new paradigm for telemedicine and validate its clinical feasibility.

METHODS

The application of this system was demonstrated for long-distance, real-time collaboration of neuroendoscopic procedures. The system consists of a local video processing workstation, a head-mounted mixed-reality display device, and a mobile remote device, connected over mobile internet (4G or 5G), allowing global point-to-point communication. Using this system, 20 cases of neuroendoscopic surgery were performed and evaluated. The system setup, composite video latency, technical feasibility, clinical implementation, and future potential business model were analyzed and evaluated.

RESULTS

The MIMIT system allows two surgeons to perform complex visual and verbal communication during the operation. The average video delay time is 184.25 msec (range 160–230 msec) with 4G mobile internet, and 23.25 msec (range 20–26 msec) with 5G mobile internet. Excellent image resolution enabled remote neurosurgeons to visualize all critical anatomical structures intraoperatively. Remote instructors could easily make marks on the surgical view; then the composite image, as well as the audio conversation, was transferred to the local surgeon. In this way, a real-time, long-distance collaboration can occur. This system was used for 20 neuroendoscopic surgeries in various cities in China and even across countries (Boston, Massachusetts, to Jingzhou, China). Its simplicity and practicality have been recognized by both parties, and there were no technically related complications recorded.

CONCLUSIONS

The MIMIT system allows for real-time, long-distance telecollaborative neuroendoscopic procedures and surgical training through a commercially available and inexpensive system. It enables remote experts to implement real-time, long-distance intraoperative interaction to guide inexperienced local surgeons, thus integrating the best medical resources and possibly promoting both diagnosis and treatment. Moreover, it can popularize and improve neurosurgical endoscopy technology in more hospitals to benefit more patients, as well as more neurosurgeons.