Digital Store and Forward Imaging as a Quality Assessment Tool for Emergency Plastic Surgery Consultations

Introduction: Plastic surgery is a frequently consulted service in most emergency departments (EDs). The inclusion of a digital image with a plastic surgery consultation would allow the consultant to immediately assess the severity of the condition and either provide instruction to ED staff if minor or mobilize resources to facilitate operative management if more severe. Methods: During a 4-month period, all plastic surgery consultations that were seen in person by one of 4 senior plastic surgery residents were included. In addition, an examination of all consultations seen during that time period at the plastic surgery clinic was undertaken to determine the quality of preclinic management. Results: During the study period, 78 ED consultations were performed by the plastic surgery residents and included in the study. During the collection period, 374 patients were seen in the plastic surgery clinic. Of these, 154 patients were ED referrals. Evaluation by the senior author revealed that all consultations seen in the ED were appropriate and needed specialist management. Of the ED referrals sent to clinic, but not seen by a plastic surgery consultant in the ED several errors in patient management were noticed. Conclusions: The study demonstrated that ED consultations were appropriate for specialty evaluation in all cases, and that insufficient consultations were placed to provide optimal medical care. The role of telemedicine in creating more efficient and effective consultation processes is promising, but numerous legal barriers must be overcome before these modalities can be widely deployed.