Purpose Statement: The importance of management of patients with problem wounds by Multidisciplinary Teams is uniformly emphasized. The aim of this study was to examine the impact of telemedicine for the triaging and management of patients with chronic, problematic wounds and to assess its usefulness for enhancement of communication between long-term care and skilled nursing facilities and the surgical wound care specialist.

Methods and Materials: Trained “field” nurse specialist assessed problem wound patients in ambulatory care setting followed by the evaluation by the Surgical Wound Care Specialist, which was a board certified plastic surgeon within two weeks of the initial consult request. A retrospective database of 120 patients was analyzed to determine whether every patient management plan has to be formulated by the multidisciplinary team. Agreement levels between the initial management plan established by the Surgical Wound Care Specialist after telemedicine consult and the final management plan by the Multidisciplinary Team based on direct, comprehensive consultation were judged by an independent investigator. In addition, the telemedicine impact on the patient was measured by assessing the duration of the subsequent face-to-face consultation and patient satisfaction with care decisions as well as by assessment of a decisional conflict scale.

Results: This preliminary study provides evidence that the telemedicine consult as the decision aid for patients referred for chronic wound management is effective. Telemedicine consults provide accurate assessment with only 1.67% (2/120 cases) change in diagnosis during the direct consultation. There was a 93.6% concordance with the management plan established by the wound care specialist based on the telemedicine consult alone in comparison to plan established by the Multidisciplinary Team with direct patient contact. The average duration of face-to-face consultation was 50+/-12 minutes vs. 35+/-6 (p<0.01) minutes for patient subjected to telemedicine feedback prior to direct consultation with a specialist. Telemedicine consults were found to be a useful aid in increasing patient satisfaction with the ultimate management plan made during direct consultation (93% vs 47% in those subjected to treatment without the intermediate telemedicine consult, p<0.01). The decisional conflict score as a state of uncertainty about the course of action taken was reduced in patients subjected to telemedicine decision aid. The type of initial management recommended (conservative vs surgical) by the consultant during face-to-face consultation had no impact of the patient satisfaction and Decisional Conflict Scores. All patients stated that the telemedicine feedback improved their understanding of their problems, the rationale for the surgeon's recommendation and was useful for their decision making process. On the other hand, the level of uncertainty regarding care recommendations and decisional conflict was higher in the group not prepared for face-to face consultation with telemedicine based "priming". The average Decisional Conflict Scale score was 14+/-1.73 versus 35+/-4 (p<0.0001) with no telemedicine contact.

Conclusion: Telemedicine consultations provide accurate assessment for the treatment of chronic problematic wounds prior to direct evaluation by a specialist. It is well received by the patient and has the potential to expedite and streamline care for patients with chronic wounds. The utilization of telemedicine can have many potential applications in plastic surgery.