UM Neurosurgeons Publish 3 Studies on Telehealth Services for Brain and Spinal Surgery Patients

Telehealth services can play an important role in the care of brain and spinal surgery patients beyond the COVID-19 pandemic, according to recent studies by members of the University of Miami Miller School of Medicine’s Department of Neurological Surgery.

“The fast-tracking of telehealth services has been one of the few silver linings of the COVID-19 pandemic,” said Allan D. Levi, M.D., Ph.D., professor and chair of neurosurgery at the Miller School, chief of neurosurgery at UM/ Jackson Memorial Hospital, and the Robert M. Buck Distinguished Chair in Neurological Surgery. “Our faculty, fellows, residents, nurse practitioners and administrative team members coordinated their efforts to overcome the challenges of rapidly implementing a telehealth program for neurosurgery patients.”

Dr. Levi was the senior author on three studies published recently in the correspondence section of Neurosurgery, the journal of the Congress of Neurological Surgeons. Two of the articles focused on implementation of telehealth services in the department, and the third was a worldwide review of telehealth studies before the COVID-19 outbreak.

“We have had a very positive experience in facilitating patient access to care through telehealth consultations and follow-up visits,” said Maggy Perez-Dickens, M.B.A., vice chair of administration for the Department of Neurological Surgery. “We hope the lessons from our experience will be helpful to the worldwide neurosurgical community in navigating the changing landscape for health care delivery.”

Lessons Learned from the Crisis

The first study, “Implementation of a Neurosurgery Telehealth Program Amid the COVID-19 Crisis—Challenges, Lessons Learned, and a Way Forward,” outlined the changes in the Miller School’s program from mid-March to mid-April, as a rapid telehealth rollout replaced traditional face-to-face encounters for evaluation and follow-up visits.

“We recognized that we would not be able to perform traditional hands-on evaluations, and needed to come up with creative approaches to assess each patient’s condition prior to surgery,” said Gregory W. Basil, M.D., neurological surgery resident and lead author of the study. “Fortunately, we were already preparing to implement a telehealth program prior to the pandemic, and were therefore well positioned to accelerate this process.”

To ensure clear and consistent steps were followed before each visit, the department’s team developed a detailed workflow for telehealth encounters, and used advanced encryption and other measures to ensure information security and patient confidentiality supported by the university.

Another technological challenge was uploading of patient images, previously provided on physical CDs. “We turned to an image-sharing platform used by many other hospital systems in Florida,” said Dr. Basil.

Prior to the telehealth visits, department staffers contacted brain and spine surgery patients to assist with video technology tools and answer questions. “Age and socio-economic factors clearly play a role in accessibility to telehealth,” said Dr. Basil. “Many patients require extensive handholding – one reason why establishing a pre-clinic workflow is so important.”

The study’s co-authors included Ricardo J. Komotar, M.D., professor of neurological surgery, director of the Sylvester Comprehensive Cancer Center Brain Tumor Initiative, director of surgical neuro-oncology and director of the Neuro-Oncology Fellowship Program; Michael E. Ivan, M.D., professor of neurological surgery and director of research at the Brain Tumor Initiative; Michael Wang, M.D., professor of neurological surgery, chief of neurosurgery at UHealth Tower, and director of the Spine Neurosurgery Fellowship Program; and Timur Urakov, M.D., assistant professor of clinical medicine.

Other co-authors were Daniel G. Eichberg, M.D., neurological surgery resident; and Ingrid Menendez, senior manager of programs, Department of Neurological Surgery; as well as Dr. Levi and Perez-Dickens.

Responding to COVID-19

The second study, “Academic Neurosurgery Department Response to COVID-19 Pandemic: The University of Miami/Jackson Memorial Hospital Model,” looked at the proactive UM strategy designed to maximize the department’s ability to provide excellent care of neurosurgical patients while minimizing risk to health care providers.

“One of the great ideas from the faculty was creating an independent subspecialty panel to decide which brain and spinal cases needed urgent treatment and which were elective,” said Dr. Eichberg, who was the lead author. “We also learned how to assess the severity of symptoms and evaluate both brain and spine conditions using a video platform, while talking with patients.”

Miller School co-authors were Kristine H. O’Phelan, M.D., associate professor of neurology; Ashish H Shah, M.D., resident; Evan M Luther, M.D., resident; and Andrea Jimenez, manager of programs; along with Dr. Levi, Menendez, and Perez-Dickens.

Reflecting on the UM program, Perez-Dickens said, “As we gradually reopened in-person clinics, we have seen that some patients still prefer telehealth visits, while others want to come to our clinics. One of the factors appears to be distance, as patients from other parts of the state prefer telehealth visits prior to surgery, so they don’t have to drive to Miami.”

A Literature Review

Neurosurgical telemedicine encounters appear promising in resource-scarce times, such as during global pandemics. That was the conclusion of a third study, “Telemedicine in Neurosurgery: Lessons Learned from a Systematic Review of the Literature for the COVID-19 Era and Beyond.”

Dr. Eichberg was the lead author, and co-authors were Miller School student Long Di, Dr. Shah, Dr. Luther, Dr. Basil, Dr. Komotar, Dr. Ivan, Dr. Levi, and Perez-Dickens.

“I was surprised by the large number of studies conducted before the pandemic,” said Dr. Eichberg. “There were 52, including 13 in the U.S. and 39 internationally. Most were related to trauma care, such as consultations prior to transferring patients.”

Patient management via telemedicine was successful in 99.6 of cases, according to the study’s authors. Issues cited in the studies included technology failures, and the need for further face-to-face evaluation or treatment.

“There were 16 studies that compared telemedicine encounters to alternative patient encounter mediums,” said Dr. Eichberg. “Telemedicine was equivalent or superior in 15 of those studies. That points to the long-term role that telemedicine can play in treating brain and spinal surgery patients.”

Tags: Department of Neurological Surgery, Dr. Allan D. Levi, Dr. Ricardo Komotar, Maggy Perez-Dickens, telehealth