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Edwards G, O'Shea JE. Is telemedicine suitable for remotely supporting non-tertiary units in providing emergency care to unwell newborns? Arch Dis Child 2023; 109:5-10. [PMID: 37438088 DOI: 10.1136/archdischild-2022-325057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/08/2023] [Indexed: 07/14/2023]
Abstract
Although the majority of term infants will breathe spontaneously at birth, the requirement for advanced resuscitation can be unpredictable, as can the precipitous delivery of an extremely preterm infant in a non-tertiary neonatal unit. Infants born in hospitals without a tertiary neonatal intensive care unit have a higher mortality which is a disparity that has been difficult to resolve.Telemedicine, the use of videoconferencing software to connect those at the scene of a resuscitation to a remote clinician, can allow for real-time two-way communication between a local unit and a tertiary neonatal specialist. It has been present for some time in neonatology to provide secure video messaging with families and its use in neonatal acute care and resuscitation has been growing in recent years.We sought to perform a review of the current evidence available on the use of telemedicine in neonatal resuscitation. Studies demonstrate improved quality of resuscitation, improved adherence to resuscitation guidelines and positive experiences reported by local and tertiary teams. Suitable technology needs to be available to establish a rapid and secure video connection, as does adequate availability of experienced neonatologists to provide remote guidance. Telemedicine is an exciting and emerging tool which is being developed as a standard of care in units which have piloted it.
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Affiliation(s)
- Gemma Edwards
- Neonatal Unit, Princess Royal Maternity Hospital, Glasgow, UK
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Castera M, Gray MM, Gest C, Motz P, Sawyer T, Umoren R. Telecoaching Improves Positive Pressure Ventilation Performance During Simulated Neonatal Resuscitations. TELEMEDICINE REPORTS 2022; 3:55-61. [PMID: 35720453 PMCID: PMC9004288 DOI: 10.1089/tmr.2021.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Positive pressure ventilation (PPV) is a critical skill for neonatal resuscitation. We hypothesized that telecoaching would improve PPV performance in neonatal providers during simulated neonatal resuscitations. SETTING Level IV neonatal intensive care unit (NICU). METHODS This prospective crossover study included 14 experienced NICU nurses and respiratory therapists who performed PPV on a mannequin that recorded parameters of ventilation efficiency. Participants were randomized to practice independently (control) or with live feedback from a remote facilitator through audiovisual connection (intervention) and then switched to the opposite group. Participants' mask leak percentage, ventilation rates, and pressure delivery were analyzed. RESULTS The primary outcome of mask leak percentage was significantly increased in the telecoaching group (19% [interquartile range {IQR} 14-59.25] vs. 100% [IQR 88-100] leak, p = 0.0001). The secondary outcome of peak inspiratory pressure (PIP) delivery was also increased (median 27.6 [IQR 23.5-34.7] vs. 23.3 [IQR 19.1-32.8] cmH2O, p < 0.001). Differences in ventilation rates were not statistically significant (55 vs. 58 breaths/min, p = 0.51). CONCLUSION Participants demonstrated better PPV performance during telecoaching with less mask leak. The intervention group also had higher measured peak inspiratory pressures. Telecoaching may be a feasible method to provide real-time feedback to health care providers during simulated neonatal resuscitations. HYPOTHESIS Neonatal providers who receive telecoaching during simulated resuscitations will perform PPV more effectively than those who do not receive telecoaching.
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Affiliation(s)
- Mark Castera
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Megan M. Gray
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Carri Gest
- Department of Neonatology, University of Washington Medical Center, Seattle, Washington, USA
| | - Patrick Motz
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Neonatology, Roseville Medical Center, Roseville, California, USA
| | - Taylor Sawyer
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Rachel Umoren
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
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Umoren R, Bucher S, Hippe DS, Ezenwa BN, Fajolu IB, Okwako FM, Feltner J, Nafula M, Musale A, Olawuyi OA, Adeboboye CO, Asangansi I, Paton C, Purkayastha S, Ezeaka CV, Esamai F. eHBB: a randomised controlled trial of virtual reality or video for neonatal resuscitation refresher training in healthcare workers in resource-scarce settings. BMJ Open 2021; 11:e048506. [PMID: 34433598 PMCID: PMC8390148 DOI: 10.1136/bmjopen-2020-048506] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the impact of mobile virtual reality (VR) simulations using electronic Helping Babies Breathe (eHBB) or video for the maintenance of neonatal resuscitation skills in healthcare workers in resource-scarce settings. DESIGN Randomised controlled trial with 6-month follow-up (2018-2020). SETTING Secondary and tertiary healthcare facilities. PARTICIPANTS 274 nurses and midwives assigned to labour and delivery, operating room and newborn care units were recruited from 20 healthcare facilities in Nigeria and Kenya and randomised to one of three groups: VR (eHBB+digital guide), video (video+digital guide) or control (digital guide only) groups before an in-person HBB course. INTERVENTIONS eHBB VR simulation or neonatal resuscitation video. MAIN OUTCOMES Healthcare worker neonatal resuscitation skills using standardised checklists in a simulated setting at 1 month, 3 months and 6 months. RESULTS Neonatal resuscitation skills pass rates were similar among the groups at 6-month follow-up for bag-and-mask ventilation (BMV) skills check (VR 28%, video 25%, control 22%, p=0.71), objective structured clinical examination (OSCE) A (VR 76%, video 76%, control 72%, p=0.78) and OSCE B (VR 62%, video 60%, control 49%, p=0.18). Relative to the immediate postcourse assessments, there was greater retention of BMV skills at 6 months in the VR group (-15% VR, p=0.10; -21% video, p<0.01, -27% control, p=0.001). OSCE B pass rates in the VR group were numerically higher at 3 months (+4%, p=0.64) and 6 months (+3%, p=0.74) and lower in the video (-21% at 3 months, p<0.001; -14% at 6 months, p=0.066) and control groups (-7% at 3 months, p=0.43; -14% at 6 months, p=0.10). On follow-up survey, 95% (n=65) of respondents in the VR group and 98% (n=82) in the video group would use their assigned intervention again. CONCLUSION eHBB VR training was highly acceptable to healthcare workers in low-income to middle-income countries and may provide additional support for neonatal resuscitation skills retention compared with other digital interventions.
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Affiliation(s)
- Rachel Umoren
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Sherri Bucher
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | | | | | | | - John Feltner
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | | | | | - Olubukola A Olawuyi
- Department of Paediatrics, University of Lagos College of Medicine, Lagos, Nigeria
| | | | | | - Chris Paton
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford, UK
| | - Saptarshi Purkayastha
- Department of BioHealth Informatics, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
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Association of outborn versus inborn birth status on the in-hospital outcomes of neonates treated with therapeutic hypothermia: A propensity score-weighted cohort study. Resuscitation 2021; 167:82-88. [PMID: 34425153 DOI: 10.1016/j.resuscitation.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/14/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the risk of in-hospital mortality and morbidity between outborn and inborn neonates treated with whole body hypothermia. METHODS The association of outborn birth status with in-hospital mortality and morbidity, prior to NICU discharge or transfer, was assessed in a large historical cohort of neonates who had therapeutic hypothermia initiated on the day of birth. The cohort was restricted to neonates born at ≥35 weeks gestational age from 2007 to 2018. Since the sample was non-random, inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalance in baseline maternal and neonatal characteristics between outborn and inborn neonates. Cox proportional hazards regression was used to assess the association between outborn status and in-hospital mortality. RESULTS There were 4447 neonates included in the study (2463 outborn). Outborn status was not significantly associated with an increased risk of in-hospital mortality in the unadjusted cohort (HR = 1.17, 95% CI 0.97-1.42, p = 0.10) or IPW cohort (HR = 1.09, 95% CI 0.95-1.26, p = 0.22). However, in the IPW cohort, outborn neonates were significantly more likely to have seizures (28% vs 24%, p = 0.006), anticonvulsant exposure (46% vs 41%, p = 0.002), and gastrostomy tube placement (5.8% vs 3.8%, p = 0.009) during their newborn hospitalization. CONCLUSION Outborn status was not significantly associated with increased in-hospital mortality among neonates treated with whole body hypothermia. However, outborn neonates were more likely to have seizures, receive anticonvulsant treatment, and undergo gastrostomy tube placement. Further study is needed to better understand the etiologies of these outcome disparities and potential implications for long-term neurodevelopmental outcomes.
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Makkar A, Sandhu T, Machut K, Azzuqa A. Utility of telemedicine to extend neonatal intensive care support in the community. Semin Perinatol 2021; 45:151424. [PMID: 33941361 DOI: 10.1016/j.semperi.2021.151424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Moderately ill preterm infants residing in medically underserved areas are frequently transferred to tertiary care NICUs that are mostly located in urban areas, resulting in mother-infant separation, high transportation costs, and the emotional costs of limited infant visitation. In 2012, The American Academy of Pediatrics revised neonatal care guidelines, adding in-house neonatal services to the scope of Level II NICUs. Limited availability of neonatologists in medically underserved areas has prompted innovative solutions like telemedicine to meet this requirement. Telemedicine consultations for pediatric transports have demonstrated improved patient outcomes compared with phone consultation, but evidence regarding telemedicine use for neonatal transport is mostly limited to simulation settings. Also, there are limited data on telemedicine use as a primary means to provide intensive care to neonates in Level I/II NICUs. Recently, two groups demonstrated the feasibility and safety of synchronous telemedicine to guide care for premature infants at lower level NICUs. This approach prevented unnecessary transfer and appeared to provide the same quality of care that the baby would have received at the tertiary care facility. As current evidence regarding the use of telemedicine to extend intensive care is based on single-center experiences, additional research and evaluation of the effectiveness of telemedicine for this application is required. This chapter describes the use of telemedicine to support physicians at lower level nurseries and the transport team with management of critical neonates, utility as primary means to provide care at lower level NICUs, barriers for implementation, and future opportunities to enhance telemedicine's impact in NICU settings.
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Affiliation(s)
- Abhishek Makkar
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200N. Everett Drive , Oklahoma City, OK 73104, USA.
| | - Tavleen Sandhu
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200N. Everett Drive , Oklahoma City, OK 73104, USA
| | - Kerri Machut
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Abeer Azzuqa
- Division of Newborn Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Maddox LJ, Albritton J, Morse J, Latendresse G, Meek P, Minton S. Implementation and Outcomes of a Telehealth Neonatology Program in a Single Healthcare System. Front Pediatr 2021; 9:648536. [PMID: 33968852 PMCID: PMC8102672 DOI: 10.3389/fped.2021.648536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Intermountain Healthcare, an early adopter and champion for newborn video-assisted resuscitation (VAR), identified a reduction in facility-level transfers and an estimated savings of $1. 2 million in potentially avoided transfers in a 2018 study. This study was conducted to increase understanding of VAR at the individual, newborn level. Study Aim: To compare transfers to a newborn intensive care unit (NICU), length of stay (LOS), and days of life on oxygen between newborns managed by neonatal VAR and those receiving standard care (SC). Methods: This retrospective, nonequivalent group study includes infants born in an Intermountain hospital between 2013 and 2017, 34 weeks gestation or greater, and requiring oxygen support in the first 15 minutes of life. Data came from billing and clinical records from Intermountain's enterprise data warehouse and chart reviews. We used logistic regression to estimate neonatal VAR's impact on transfers. Negative binomial regression estimated the impact on LOS and days of life on supplemental oxygen. Results: The VAR intervention was used in 46.2 percent of post-implementation cases and is associated with (1) a 12 percentage points reduction in the transfer rate, p = 0.02, (2) a reduction in spoke hospital (SH) LOS of 8.33 h (p < 0.01) for all transfers; (3) a reduction in SH LOS of 2.21 h (p < 0.01) for newborns transferred within 24 h; (4) a reduction in SH LOS of 17.85 h (p = 0.06) among non-transferred newborns; (5) a reduction in days of life on supplemental oxygen of 1.4 days (p = 0.08) among all transferred newborns, and (6) a reduction in days of life on supplemental oxygen of 0.41 days (p = 0.04) among non-transferred newborns. Conclusion: This study provides evidence that neonatal VAR improves care quality and increases local hospitals' capabilities to keep patients close to home. There is an ongoing demand for support to rural and community hospitals for urgent newborn resuscitations, and complex, mandatory NICU transfers. Efforts may be necessary to encourage neonatal VAR since the intervention was only used in 46.2 percent of this study's potential cases. Additional work is needed to understand the short- and long-term impacts of Neonatal VAR on health outcomes.
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Affiliation(s)
- Lory J Maddox
- Intermountain Connect, Intermountain Healthcare, Salt Lake City, UT, United States.,College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Jordan Albritton
- Intermountain Connect, Intermountain Healthcare, Salt Lake City, UT, United States.,RTI International, Research Triangle Park, Durham, NC, United States
| | - Janice Morse
- College of Nursing, University of Utah, Salt Lake City, UT, United States.,University of Alberta, Edmonton, AB, Canada
| | - Gwen Latendresse
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Paula Meek
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Stephen Minton
- Neonatal TeleHealth Intermountain Healthcare, Salt Lake City, UT, United States
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7
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Fang JL, Chuo J. Using telehealth to support pediatricians in newborn care. Curr Probl Pediatr Adolesc Health Care 2021; 51:100952. [PMID: 33531258 PMCID: PMC8693894 DOI: 10.1016/j.cppeds.2021.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This clinical scenario-based review will discuss how telehealth programs improve access to specialty care for neonates, their caregivers, and primary care pediatricians. Tele-resuscitation supports pediatricians during complex, high-risk newborn resuscitations, improves the quality of delivery room care, and reduces odds of transfer to a higher level of care. Neonatologists and other pediatric specialists use telehealth to provide more effective consultations that positively influence management decisions and patient outcomes. When neonatologists provide video visits to home and meet virtually with primary care pediatricians, infants discharged from the NICU experience fewer emergency room visits and hospital re-admissions. With further implementation and dissemination of neonatal telemedicine programs, it is important that these programs continue to be thoughtfully designed to achieve measurable value that is relevant to patients and caregivers, providers, healthcare systems, and payers.
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Affiliation(s)
- Jennifer L Fang
- Division of Neonatal Medicine, Mayo Clinic, 200 First St. SW, Rochester MN, 55905, United States.
| | - John Chuo
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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8
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Brei BK, Neches S, Gray MM, Handley S, Castera M, Hedstrom A, D'Cruz R, Kolnik S, Strandjord T, Mietzsch U, Cooper C, Moore JM, Billimoria Z, Sawyer T, Umoren R. Telehealth Training During the COVID-19 Pandemic: A Feasibility Study of Large Group Multiplatform Telesimulation Training. Telemed J E Health 2020; 27:1166-1173. [PMID: 33395364 DOI: 10.1089/tmj.2020.0357] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Video telehealth is an important tool for health care delivery during the COVID-19 pandemic. Given physical distancing recommendations, access to traditional in-person telehealth training for providers has been limited. Telesimulation is an alternative to in-person telehealth training. Telesimulation training with both remote participants and facilitators using telehealth software has not been described. Objective: We investigated the feasibility of a large group telesimulation provider training of telehealth software for remote team leadership skills with common neonatal cases and procedures. Methods: We conducted a 90-min telesimulation session with a combination of InTouch™ provider access software and Zoom™ teleconferencing software. Zoom facilitators activated InTouch software and devices and shared their screen with remote participants. Participants rotated through skill stations and case scenarios through Zoom and directed bedside facilitators to perform simulated tasks using the shared screen and audio connection. Participants engaged in a debrief and a pre- and postsurvey assessing participants' comfort and readiness to use telemedicine. Data were analyzed using descriptive statistics and paired t tests. Results: Twenty (n = 20) participants, five Zoom and eight bedside facilitators participated. Twenty-one (21) pre- and 16 postsurveys were completed. Most participants were attending neonatologists who rarely used telemedicine software. Postsession, participants reported increased comfort with some advanced InTouch features, including taking and sharing pictures with the patient (p < 0.01) and drawing on the shared image (p < 0.05), but less comfort with troubleshooting technical issues, including audio and stethoscope (p < 0.01). Frequently stated concerns were troubleshooting technical issues during a call (75%, n = 16) and personal discomfort with telemedicine applications and technology (56%, n = 16). Conclusion: Large group telesimulation is a feasible way to offer telehealth training for physicians and can increase provider comfort with telehealth software.
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Affiliation(s)
- Brianna K Brei
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA.,Division of Neonatology, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sara Neches
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Megan M Gray
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Sarah Handley
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Mark Castera
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Anna Hedstrom
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Ravi D'Cruz
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Sarah Kolnik
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Thomas Strandjord
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Ulrike Mietzsch
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Christine Cooper
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Jami M Moore
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Zeenia Billimoria
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Taylor Sawyer
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
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9
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Haynes SC, Dharmar M, Hill BC, Hoffman KR, Donohue LT, Kuhn-Riordon KM, Rottkamp CA, Vali P, Tancredi DJ, Romano PS, Steinhorn R, Marcin JP. The Impact of Telemedicine on Transfer Rates of Newborns at Rural Community Hospitals. Acad Pediatr 2020; 20:636-641. [PMID: 32081766 DOI: 10.1016/j.acap.2020.02.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Telemedicine may have the ability to reduce avoidable transfers by allowing remote specialists the opportunity to more effectively assess patients during consultations. In this study, we examined whether telemedicine consultations were associated with reduced transfer rates compared to telephone consultations among a cohort of term and late preterm newborns. We hypothesized that neonatologist consultations conducted over telemedicine would result in fewer interfacility transfers than consultations conducted over telephone. METHODS We collected data on all newborns who received a neonatal telemedicine or telephone consultation at 6 rural hospitals in northern and central California between August 2014 and June 2018. We used adjusted analyses to compare transfer rates between telemedicine and telephone cohorts. RESULTS A total of 317 patients were included in the analysis; 89 (28.1%) of these patients received a telemedicine consultation and 228 (71.9%) received a telephone consultation only. The overall transfer rate was 77.0%. Patient consultations conducted using telemedicine were significantly less likely to result in a transfer than patient consultations conducted using the telephone (64.0% vs 82.0%, P = .001). After controlling for 5-minute Apgar score, birthweight, gestational age, site of consultation, and Transport Risk Index of Physiologic Stability score, the odds of transfer for telemedicine consultations was 0.48 (95% confidence interval: 0.26, 0.90, P = .02). CONCLUSIONS Our findings suggest that telemedicine may have the potential to reduce potentially avoidable transfers of term and late preterm newborns. Future research on potentially avoidable transfers and patient outcomes is needed to better understand the ways in which telemedicine affects clinical decision-making.
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Affiliation(s)
- Sarah C Haynes
- Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif.
| | - Madan Dharmar
- Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif
| | - Barry C Hill
- Center for Healthcare Policy and Research, University of California Davis (BC Hill, DJ Tancredi, and PS Romano), Sacramento, Calif
| | - Kristin R Hoffman
- Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif
| | - Lee T Donohue
- Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif
| | - Kara M Kuhn-Riordon
- Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif
| | - Catherine A Rottkamp
- Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif
| | - Payam Vali
- Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif
| | - Daniel J Tancredi
- Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif; Center for Healthcare Policy and Research, University of California Davis (BC Hill, DJ Tancredi, and PS Romano), Sacramento, Calif
| | - Patrick S Romano
- Center for Healthcare Policy and Research, University of California Davis (BC Hill, DJ Tancredi, and PS Romano), Sacramento, Calif; Department of Internal Medicine, UC Davis Health (PS Romano), Sacramento, Calif
| | - Robin Steinhorn
- Children's National Health System (JP Marcin), Washington, DC
| | - James P Marcin
- Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif
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10
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Umoren RA, Gray MM, Handley S, Johnson N, Kunimura C, Mietzsch U, Billimoria Z, Lo MD. In-Hospital Telehealth Supports Care for Neonatal Patients in Strict Isolation. Am J Perinatol 2020; 37:857-860. [PMID: 32268382 PMCID: PMC7356060 DOI: 10.1055/s-0040-1709687] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study is to determine the feasibility of "in-hospital" inpatient telemedicine within a children's referral hospital to facilitate inpatient care activities such as interprofessional rounding and the provision of supportive services such as lactation consultations to pediatric patients in strict isolation. To test the feasibility of in-hospital video telemedicine, a dedicated telemedicine device was set up in the patient's room. This device and the accompanying Bluetooth stethoscope were used by the health care team located just outside the room for inpatient rounding and consultations from supportive services. Video telemedicine facilitated inpatient care and interactions with support services, reducing the number of health care providers with potential exposure to infection and decreasing personal protective equipment use. In the setting of strict isolation for highly infectious viral illness, telemedicine can be used for inpatient care activities such as interprofessional rounding and provision of supportive services. KEY POINTS: · Telehealth supports patient care in isolation.. · Telehealth reduced health care provider exposures.. · Telehealth conserves personal protective equipment..
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Affiliation(s)
- Rachel A. Umoren
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington,Address for correspondence Rachel A. Umoren, MBBCh, MS Department of Pediatrics, Division of Neonatology1959 NE Pacific Street, Box 356320, Seattle, WA 98195
| | - Megan M. Gray
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Sarah Handley
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Nathaniel Johnson
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Christina Kunimura
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Digital Health Innovation, Seattle Children's Hospital, Seattle, Washington
| | - Ulrike Mietzsch
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Zeenia Billimoria
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Mark D. Lo
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington
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Okada J, Hisano T, Unno M, Tanaka Y, Saikusa M, Kinoshita M, Harada E, Iwata S, Iwata O. Video-call based newborn triage system for local birth centres can be established without major instalment costs using commercially available smartphones. Sci Rep 2020; 10:7552. [PMID: 32371906 PMCID: PMC7200688 DOI: 10.1038/s41598-020-64223-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022] Open
Abstract
Neonates often develop transition problems after low-risk birth, precise assessment of which is difficult at primary birth centres. The aim of this study was to assess whether a video triage system can be established without a specially designed communication system between local birth centres and a tertiary neonatal intensive care unit in a region with a population of 700,000. 761 neonates who were referred to a tertiary neonatal intensive care unit were examined. During period 1 (April 2011-August 2015), only a voice call was available for consultations, whereas, during period 2 (September 2015-December 2017), a video call was additionally available. The respiratory condition was assessed based on an established visual assessment tool. A video consultation system was established by connecting personal smartphones at local birth centres with a host computer at a tertiary neonatal intensive care centre. During period 2, video-based triage was performed for 42.4% of 236 consultations at 30 birth centres. Sensitivity and specificity for predicting newborns with critical respiratory dysfunction changed from 0.758 to 0.898 and 0.684 to 0.661, respectively. A video consultation system for ill neonates was established without major instalment costs. Our strategy might improve the transportation system in both high- and low-resource settings.
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Affiliation(s)
- Junichiro Okada
- Division of Neonatology, St. Mary's Hospital, Fukuoka, Japan
| | - Tadashi Hisano
- Division of Neonatology, St. Mary's Hospital, Fukuoka, Japan
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Mitsuaki Unno
- Division of Neonatology, St. Mary's Hospital, Fukuoka, Japan
| | - Yukari Tanaka
- Division of Neonatology, St. Mary's Hospital, Fukuoka, Japan
| | - Mamoru Saikusa
- Division of Neonatology, St. Mary's Hospital, Fukuoka, Japan
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Masahiro Kinoshita
- Division of Neonatology, St. Mary's Hospital, Fukuoka, Japan
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Eimei Harada
- Division of Neonatology, St. Mary's Hospital, Fukuoka, Japan
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Sachiko Iwata
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Osuke Iwata
- Division of Neonatology, St. Mary's Hospital, Fukuoka, Japan.
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan.
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12
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Neonatal transport in California: findings from a qualitative investigation. J Perinatol 2020; 40:394-403. [PMID: 31270432 PMCID: PMC7223647 DOI: 10.1038/s41372-019-0409-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/28/2019] [Accepted: 05/17/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify characteristics of neonatal transport in California and which factors influence team performance. STUDY DESIGN We led focus group discussions with 19 transport teams operating in California, interviewing 158 neonatal transport team members. Transcripts were analyzed using a thematic analysis approach. RESULT The composition of transport teams varied widely. There was strong thematic resonance to suggest that the nature of emergent neonatal transports is unpredictable and poses several significant challenges including staffing, ambulance availability, and administrative support. Teams reported dealing with this unpredictability by engaging in teamwork, gathering experience with staff at referral hospitals, planning for a wide variety of circumstances, specialized training, debriefing after events, and implementing quality improvement strategies. CONCLUSION Our findings suggest potential opportunities for improvement in neonatal transport. Future research can explore the cost and benefits of strategies such as dedicated transport services, transfer centers, and telemedicine.
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Donohue LT, Hoffman KR, Marcin JP. Use of Telemedicine to Improve Neonatal Resuscitation. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E50. [PMID: 30939758 PMCID: PMC6518228 DOI: 10.3390/children6040050] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 12/14/2022]
Abstract
Most newborn infants do well at birth; however, some require immediate attention by a team with advanced resuscitation skills. Providers at rural or community hospitals do not have as much opportunity for practice of their resuscitation skills as providers at larger centers and are, therefore, often unable to provide the high level of care needed in an emergency. Education through telemedicine can bring additional training opportunities to these rural sites in a low-resource model in order to better prepare them for advanced neonatal resuscitation. Telemedicine also offers the opportunity to immediately bring a more experienced team to newborns to provide support or even lead the resuscitation. Telemedicine can also be used to train and assist in the performance of emergent procedures occasionally required during a neonatal resuscitation including airway management, needle thoracentesis, and umbilical line placement. Telemedicine can provide unique opportunities to significantly increase the quality of neonatal resuscitation and stabilization in rural or community hospitals.
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Affiliation(s)
- Lee T Donohue
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
| | - Kristin R Hoffman
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
| | - James P Marcin
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
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