Integration of quality programs by telemedicine in surgical services

Surgical procedures can be performed and monitored in operating rooms physi cally isolated, but electronically linked to a parent medical center, and c ertainly from distant consultation. Quality of surgical care has been measu red in retrospect rather than in real time, and outcomes have generally not had the benefit of immediate consultation and group analysis. However, tel emedicine can connect consultants, surgeons, patients, and databases. The Y ale Telemedicine Center has developed network schemes, which connect the OR of trainees with the laboratory of the teacher, and has opened a continuum between pedagogy and product. The program has connected regional hospitals , connected components of hospital systems, and has been used in internatio nal testbeds. The particular operative procedures studied have been laparos copic procedures. The consultant is based at Yak and is connected with the distant OR to share the laparoscopic surgical field. Connection includes re al time video, audio and the ability to draw instruction on the OR screen. Bandwidths as low as 12kbs(POTS) have been employed with modification with effective intervention. The potential for quality improvement is substantia l, and inclusion in quality programs is strongly recommended.