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Barriers and facilitators in the implementation of a telemedicine-based outpatient brain tumor surgery program

Abstract: Objective: Despite growing evidence on the benefits of outpatient oncological neurosurgery (OON), it is only performed in a few specialized centers and there are no previous descriptions of established OON programs in Europe. Moreover, increasing application of telemedicine strategies, especially after the start of the coronavirus disease 2019 (COVID-19) pandemic, is drastically changing neurosurgical management, particularly in the case of vulnerable populations such as neuro-oncological patients. In this context, the authors implemented an OON program in their hospital with telematic follow-up. Herein, they describe the protocol and qualitatively analyze the barriers and facilitators of the development process. Methods: An OON program was developed through the following steps: assessment of hospital needs, specific OON training, multidisciplinary team organization, and OON protocol design. In addition, the implementation phase included training sessions, a pilot study, and continuous improvement sessions. Finally, barriers and facilitators of the protocol's implementation were identified from the feedback of all participants. Results: An OON protocol was successfully designed and implemented for resection or biopsy of supratentorial lesions up to 3 cm in diameter. The protocol included the patient's admission to the day surgery unit, noninvasive anesthetic monitoring, same-day discharge, and admission to the hospital-at-home (HaH) unit for telematic and on-site postoperative care. After a pilot study including 10 procedures in 9 patients, the main barriers identified were healthcare provider resistance to change, lack of experience in outpatient neurosurgery, patient reluctance, and limitations in the recruitment of patients. Key facilitators of the process were the patient education program, the multidisciplinary team approach, and the HaH-based telematic postoperative care. Conclusions: Initiating an OON program with telematic follow-up in a European clinical setting is feasible. Nevertheless, it poses several barriers that can be overcome by identifying and maximizing key facilitators of the process. Among them, patient education, a multidisciplinary team approach, and HaH-based postoperative care were crucial to the success of the program. Future studies should investigate the cost-effectiveness of telemedicine to assess potential cost savings, from reduced travel and wait times, and the impact on patient satisfaction.

Otras publicaciones de la misma revista o congreso con autores/as de la Universidad de Cantabria

 Fuente: Neurosurg Focus . 2022 Jun;52(6):E8

Editorial: American Association of Neurological Surgeons

 Año de publicación: 2022

Nº de páginas: 11

Tipo de publicación: Artículo de Revista

 DOI: 10.3171/2022.3.FOCUS2242

ISSN: 1092-0684

Url de la publicación: https://www.doi.org/10.3171/2022.3.FOCUS2242

Autoría

MORA, CARLA

SAMPEDRO, ISABEL

RODRÍGUEZ-CABALLERO, ANGELINA

MARTÍN-LÁEZ, RUBÉN

ORTEGA-ROLDÁN, MARTA

VENKATRAGHAVAN, LASHMI

FERNÁNDEZ-MIERA, MANUEL

VAREA, MAR

PAJARON-GUERRERO, MARCOS

ESTEBAN, JESUS

MORENO, BLANCA

MANZANO, ASUNCIÓN

RUIZ, ISABEL

ZADEH, GELAREH

BERNSTEIN, MARK