Telemedicine And Neurosurgery: Experience Of A Regional Unit Based In Kwazulu-Natal

Purpose of Study
A tele-fax assisted neurosurgery consultation-referral system has been operational at Wentworth hospital since March 1991. The purpose of this report was to determine whether the introduction of such a referral system was useful in providing an efficient neurosurgical service for the province of KwaZulu-Natal (KZN) and whether this service improved patient management and outcome.

Methods
This study comprised a dual analysis. A retrospective audit of all patients seen by emergency consultation from 1996 to 1999 was reviewed to establish if the return rate of patients from hospitals with linked CT scanners had reduced.

To determine if patient care was compromised by the new referral process and in particular the outcome of patients who remained at their referral hospitals, a prospective analysis of 100 consecutive telefax-assisted consultations was audited during the period January to March 2000.

Results
The establishment of a telefax assisted consultation process has decreased the number of inappropriate inter-hospital transfers and improved the care and outcome of polytrauma patients. A significant reduction in patient return rate was noted during the study period. Of the 100 telefax-assisted consultations collected prospectively, 45 of 57 patients (79%) who remained at their referral hospitals had a good outcome while 3 patients (5.2%) had a poor outcome and 9 patients (15.8%) died.

Conclusion
The establishment of a telefax assisted consultation-referral process has decreased the number of inappropriate inter-hospital transfers while maintaining patient care and improving outcome.