Elsevier

World Neurosurgery

Volume 150, June 2021, Pages e539-e549
World Neurosurgery

Original Article
Telehealth Adoption Across Neurosurgical Subspecialties at a Single Academic Institution During the COVID-19 Pandemic

https://doi.org/10.1016/j.wneu.2021.03.062Get rights and content

Objective

The COVID-19 pandemic has dramatically changed health care, forcing providers to adopt and implement telehealth technology to provide continuous care for their patients. Amid this rapid transition from in-person to remote visits, differences in telehealth utilization have arisen among neurosurgical subspecialties. In this study, we analyze the impact of telehealth on neurosurgical healthcare delivery during the COVID-19 pandemic at our institution and highlight differences in telehealth utilization across different neurosurgical subspecialties.

Methods

To quantify differences in telehealth utilization, we analyzed all outpatient neurosurgery visits at a single academic institution. Internal surveys were administered to neurosurgeons and to patients to determine both physician and patient satisfaction with telehealth visits. Patient Likelihood-to-Recommend Press-Ganey scores were also evaluated.

Results

There was a decrease in outpatient visits during the COVID-19 pandemic in all neurosurgical subspecialties. Telehealth adoption was higher in spine, tumor, and interventional pain than in functional, peripheral nerve, or vascular neurosurgery. Neurosurgeons agreed that telehealth was an efficient (92%) and effective (85%) methodology; however, they noted it was more difficult to evaluate and bond with patients. The majority of patients were satisfied with their video visits and would recommend video visits over in-person visits.

Conclusions

During the COVID-19 pandemic, neurosurgical subspecialties varied in adoption of telehealth, which may be due to the specific nature of each subspecialty and their necessity to perform in-person evaluations. Telehealth visits will likely continue after the pandemic as they can improve clinical efficiency; overall, both patients and physicians are satisfied with health care delivery over video.

Introduction

Telemedicine, or the remote diagnosis and treatment of patients by means of telecommunications technology, has been used in clinical practice for decades,1 with orthopedic surgeons reporting using traditional telephones to remotely examine patients in 1999.1,2 Although sometimes used interchangeably with telemedicine, telehealth is a broader term that describes the delivery of health care, health education, and health information services via remote technologies such as mobile health, video and audio technologies, and remote patient monitoring.1

The COVID-19 pandemic has led to rapid adoption and implementation of telehealth.3 At our institution, telehealth visits were implemented over 2 weeks in March 2020, a project that was initially intended to occur over several years. In this study, we present our experience with neurosurgery telehealth visits at a single academic institution before and during the COVID-19 pandemic. To the best of our knowledge, this is the first paper to assess telehealth utilization at different points during the pandemic and by different neurosurgical subspecialties, while also secondarily evaluating patient and physician satisfaction with telehealth visits during this time.

Section snippets

Methods

We retrospectively analyzed adoption of telehealth at our institution as a whole and in the following specialties during the COVID-19 pandemic (March 2020 to December 2020): cardiology, dermatology, endocrinology, ENT-otolaryngology, primary care, internal medicine, neurology, neurosurgery, ophthalmology, orthopaedics, psychiatry and urology (Figure 1).

Next, we retrospectively reviewed all neurosurgery visits performed from January 1, 2019, through November 2, 2020, at the outpatient clinic of

Results

During the COVID-19 pandemic, our institution used phone or video for an average (±SD) 24.1% (±9.8%) of all patient visits. The neurosurgery department observed a higher adoption of telehealth visits, 37.9% (±10.7%) (Figure 1).

Over the study period, our neurosurgery outpatient clinic had a mean (±SD) of 284 ± 69 visits per week, of which 36% were spine, 33% tumor, 10% pain, 8% vascular, 5% functional, 5% peripheral nerve, and 2% trauma (Supplemental Figure 1).

Between phase 0 (control/baseline,

Discussion

Development and use of telehealth technologies have increased worldwide over the last decade. Prior to the COVID pandemic, the market value of telehealth in the United States was expected to reach $36.2 billion by 2022.4 In 2013, 22 million telehealth visits were performed in the United States, increasing to 30 million in 2017, with an anticipated 46–81 million telehealth visits by 2022.5 In June 2018, over 50% of U.S. hospitals had telehealth programs, and 90% of executives stated their

CONCLUSIONS

Patients and providers uniformly reported positive experiences with video visits at our institution. There are differences in telehealth utilization across neurosurgical subspecialties, with certain specialties (pain, tumor, trauma) being more amenable to video visits than others (e.g., peripheral nerve or functional neurosurgery). Patient LTR did not change with the implementation of video visits. Given these findings, we believe that telehealth will be a valuable tool for neurosurgeons to

CRediT authorship contribution statement

Christopher Leung: Methodology, Formal analysis, Investigation, Writing - original draft, Visualization. Harsh Wadhwa: Formal analysis, Writing - review & editing. Matthew Sklar: Methodology, Validation. Kunj Sheth: Conceptualization. Sophia Loo: Methodology. John Ratliff: Writing - review & editing. Corinna C. Zygourakis: Conceptualization, Writing - review & editing, Supervision.

References (19)

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Conflict of interest statement: C.C. Zygourakis is a consultant for Stryker, 7D, Globus, and SpineAlign.

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