An e-Health approach to managing vascular surgical patients

The objective of this study was to investigate an e-health approach to managing patients presenting with vascular-type symptoms. A pilot study of a prospective cohort of patients referred from a single general practitioner practice of 5700 patients using electronic referral, assessment by a practice nurse, and teleconferencing facilities as an adjunct to normal referral and management practice was designed and conducted. Thirty-eight patients aged 30-93 years old (median 72 years) were enrolled in the study between March 2001 and July 2004. Twelve patients had leg ulceration and 12 complained of leg pain. The remainder had a range of symptoms potentially vascular in nature. All but 1 patient had an initial teleconsultation. This initial teleconsultation lasted a median of 11 minutes (interquartile range 9 minutes (min) 59 seconds (sec)-12 min 43 sec). For 10 patients this was their only contact with the hospital. One patient had teleconsultation follow-up only, 26 patients attended the hospital for vascular laboratory studies or angiography, and 8 of these went on to have radiological and/or surgical intervention. Three patients attended the outpatient department for follow up; all other follow-ups were managed via the teleclinic. Overall, 57 standard outpatient attendances in these patients were replaced by teleconsultations. Common vascular-type symptoms can be satisfactorily evaluated across a telelink with the aid of a practice nurse and baseline patient data transmitted electronically. Decisions can be made regarding the need for further investigation and attendance in outpatient clinic can be largely eliminated.