Innovations in the Plastic Surgery Care Pathway: Using Telemedicine for Clinical Efficiency and Patient Satisfaction

Plast Reconstr Surg. 2019 Aug;144(2):507-516. doi: 10.1097/PRS.0000000000005884.


Background: Telemedicine delivers clinical information and permits discussion between providers and patients at a distance. Postoperative visits may be a burden to patients-many of whom travel long distances and miss work opportunities. By implementing a telehealth opportunity, the authors sought to develop a process that optimizes efficiency and provides optimal patient satisfaction.

Methods: Using quality improvement methods that have been highly effective in the business sector, we developed a testable workflow for patients in the postoperative telehealth setting. Seventy-two patients were enrolled and surveyed. A preoperative survey sought to determine travel distance, comfort with technology, access to the Internet and video-enabled devices, and the patient's interest in telehealth. A postoperative survey focused on patient satisfaction with the experience.

Results: Using the Lean Six Sigma methodology, the authors developed a telehealth workflow to optimize clinical efficiency. Preoperative surveys revealed that the majority (73 percent) of patients preferred in-person follow-up visits in the clinic. However, the postoperative survey distributed after the telehealth encounter found that nearly 100 percent of patients were satisfied with the telehealth experience. Ninety-six percent of patients said that their questions were answered, and 97 percent of patients stated that they would use telehealth again in the future.

Conclusions: Telehealth encounters enable real-time clinical decision-making by providing patients and visiting nurses access to providers and decreasing patient transportation needs and wait times. Although initially hesitant to opt for a telehealth encounter in lieu of a traditional visit, the great majority of patients voiced satisfaction with the telehealth experience.

Clinical question/level of evidence: Therapeutic, IV.

MeSH terms

  • Adult
  • Aged
  • Cost of Illness
  • Critical Pathways
  • Esthetics
  • Female
  • Health Care Costs*
  • Humans
  • Male
  • Middle Aged
  • Patient Satisfaction / statistics & numerical data*
  • Postoperative Care / economics*
  • Postoperative Care / methods
  • Surgery, Plastic / economics*
  • Surgery, Plastic / methods*
  • Telemedicine / economics
  • Telemedicine / methods*
  • Treatment Outcome
  • United States