Live Feed Cystoscopies Between Rota and Naples

Photo By Christina Clarke | Lt. Cdr. Kathryn Lipscomb, the Urology department head at USNH Rota, Spain, waves to staff in USNH Naples, Italy during the first virtual cystoscopy between both hospitals, Jan 22, 2021. (U.S. Navy Photo by Cmdr. Ryan Nations).  

ROTA, SPAIN

03.08.2021

Courtesy Story

U.S. Naval Hospital Naples

LCDR Kathryn Lipscomb MD, LT Olivia Peduzzi RN, LT Megan McKim RN, HM2 Kevin Moorman

Telehealth is an innovative means of delivering healthcare in remote environments. For isolated Military Treatment Facilities (MTFs) and naval vessels at sea, access to specialized healthcare is often geographically limited, requiring the use of host nation resources or temporary additional duty (TAD) assignment to larger MTFs for care. This process is cumbersome, resulting in increased healthcare costs, lost man-hours from work, patient dissatisfaction, and potential for COVID exposure. Harnessing Lean Six Sigma (LSS) methodology, U.S. Naval Hospital (USNH) Rota, Spain was able to pilot a Tele-Urology program in January 2020 and implemented a standardized process that allowed USNH Naples, Italy beneficiaries to receive Urology consultations.

Traditionally the sole SIXTH FLEET Urologist is stationed in USNH Rota and visits Naples on average every three months to see patients under the Circuit Rider Program. With the global pandemic escalating in early 2020, travel halted to prevent the spread of COVID-19. The last time Urology was able to visit USNH Naples physically was February 2020. USNH Rota leveraged its fledgling Tele-Urology program to continue providing access to care during the European State of Alarm.

After the pilot program's remarkable success and increased demand for telehealth specialty care, the team explored additional opportunities to expand the telehealth program. Virtual Health experts from USNH Rota and Naples redoubled efforts to improve virtual care in the COVID environment. Tele-Urology continued to provide virtual appointments in anticipation of returning to USNH Naples. However, as the global pandemic surged, restrictions returned for the remainder of 2020. Return of travel constraints required innovative problem solving to ensure Urology patients received timely care.

USNH Naples suggested performing live feed virtual cystoscopies to increase utilization and support virtual Urology care to USNH Naples beneficiaries. In October 2020, USNH Rota Urology Staff reviewed patient encounters pending cystoscopy, a procedure used to rule out bladder cancer or other bladder abnormalities. Once the demand signal was determined, USNH Rota Urology consulted with the USNH Naples Surgical Team. USNH Naples Surgical Team identified two providers credentialed to perform cystoscopies independently. Both MTFs attempted multiple methods to allow the Urologist to view a cystoscopy live feed without success.

After exhausting all concepts, USNH Rota Urology consulted with USNH Rota Telehealth. The Telehealth department at Rota bridged the team with the Naval Medical Forces Atlantic (MEDLANT) Virtual Health Project Manager to assist with connectivity. Using existing infrastructure, the team connected a Cisco DX80 in Rota and a Global Med Cart in Naples, which provided live access to Stryker cystoscopy video. On 03 February 2021, USNH Rota Urology observed a standard post-GYN surgical cystoscopy, successfully providing proof of concept.

One year after implementation, the Tele-Urology program completed 51 appointments averaging over 9 telehealth appointments per month. This initiative resulted in a total cost avoidance of approximately $92,021, and decreased time away from work by 138 hours. Additionally, by the end of February 2021, two live virtual Urology cystoscopies were completed, with no patient complications.

“The COVID era has pushed modern medicine to adapt and overcome in so many ways in the last year. We have found ourselves balancing ensuring patient safety, medical readiness of the active duty member, health of their family, and our commitment to provide world class quality care to all beneficiaries across the globe. Programs like this aim to limit risk to patient, and reduce the cost of lost man-hours and out of network care. Expanding our virtual health capabilities to include procedures allows us to continue to provide specialized care that is timely, high quality, and low cost. BZ to Navy Medicine and thanks to everyone who has contributed their time and expertise to this venture," said Lt. Cdr. Kathryn Lipscomb, MD, USNH Rota Urology Department Head.

• Date Taken: 03.08.2021
• Date Posted: 03.08.2021 06:47
• Story ID: 390803
• Location: ROTA, ES