Introduction: The centre provides hand services to remote hospitals which require patients to travel long distances at odd hours for assessment and consenting to their operation only to be done at a later date in day surgery unit unless otherwise indicated.

Aims: Compare video conferencing to patient and surgeon ‘face to face’ consultation in counselling of patients prior to surgery.

Methods: Four injuries (Nail bed, extensor tendon, nerve repair, wrist laceration) were identified for which operative management was clear. 10 plastic surgery SHOs were shown photographs of the patients injury and asked to ‘counsel’ the ‘patient’(played by consultant plastic surgeon) with regards to the intended benefits, risks and complications of surgery.

The assessment was done for all four scenarios both in person and over a video conference link (AHMS). The order of each case was varied to minimise ‘rehearsal’ of the consent. The consent process was scored on a number of points followed by rating. SHOs acted as their own controls removing bias of differing levels of knowledge.

Results: The mean counselling time was 6 minutes/session. Equipments functioned reliably with audio and speed rated as excellent. Quality of councelling sessions using telemedicine was considered by consultants as good (32/40) to satisfactory (8/40) and was found comparable to in person councelling in obtaining consent.

Conclusion: Telemedicine is as effective as specialist-on site counselling for non-controversial hand injuries and thereby reduces the movement of patients from remote A& E departments to plastic surgery units for consent and booking of their surgery.