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

Funderburk, Christopher D. M.D., M.S.; Batulis, Nicole S. M.H.A.; Zelones, Justin T. M.D.; Fisher, Alec H. B.A.; Prock, Kimberly L. B.A.; Markov, Nickolay P. M.D.; Evans, Alison E. A.P.R.N.; Nigriny, John F. M.D.

Plastic and Reconstructive Surgery: August 2019 - Volume 144 - Issue 2 - p 507-516
doi: 10.1097/PRS.0000000000005884
Plastic Surgery Focus: Technology and Innovations
Press Release
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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.


Lebanon and Hanover, N.H.; and New Haven, Conn.

From the Division of Plastic Surgery and The Value Institute Learning Center, Dartmouth-Hitchcock Medical Center; the Geisel School of Medicine at Dartmouth; and Yale Plastic and Reconstructive Surgery.

Received for publication May 16, 2018; accepted January 18, 2019.

Presented at the 5th Annual Surgical Trainees Advancing Research Symposium, in Lebanon, New Hampshire, April 13 through 14, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.

“Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (

John F. Nigriny, M.D., Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, N.H. 03756,

Copyright © 2019 by the American Society of Plastic Surgeons