Key result
Remote consultation alters surgical plans in ~25% of stroke cases and rapidly builds local autonomy.
Observational (n=12)
Yes
We studied knowledge transfer for the determination of the suitability of stroke patients for a specialist surgical procedure (split anterior tibial tendon transfer). Gait analysis data from patients at a general hospital were discussed with an expert in another country using personal computers, an ISDN connection (128 kbit/s) and TCP/IP-based communication tools. The key issue was whether the staff in the general hospital became better able to determine suitability for surgery. Twelve patients were studied. In three of the first four cases the advice of the remote expert changed the plan for surgery. After that the treatment plans did not change after consultation. After eight cases the local clinicians did not need to ask for further advice. There was a rapid increase in skill in determining suitability for surgery. The experience and skills of the local clinicians were thought to increase more rapidly than would have been the case without the consultations with a remote expert.
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Buurke et al. (2004) conducted an observational in Stroke rehabilitation (n=12). Remote consultation with an international expert via ISDN and TCP/IP-based communication tools was evaluated on Change in surgical treatment plan and local clinician skill in determining suitability for split anterior tibial tendon transfer surgery. Remote consultation changed surgical plans in 3 of the first 4 stroke patients (25% overall), and after 8 of 12 cases local clinicians no longer needed remote advice to determine surgical suitability.
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