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Cooper C, Mastroianni R, Bosque E, Chabra S, Campbell J, Perez JA, White CF, James JE, Umoren RA. Quality Indices and Outcomes of a Neonatology Telerounding Program in a Level II Neonatal Intensive Care Unit: Single-Center Experience during the COVID-19 Pandemic. Am J Perinatol 2024; 41:e2436-e2443. [PMID: 37348545 DOI: 10.1055/a-2115-8530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE The objective of this program evaluation was to describe the outcomes of daily neonatologist telerounding with the onsite advanced practice provider (APP) in a Level II neonatal intensive care unit (NICU), before and during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN Bedside telerounding occurred with an onsite APP using a telehealth cart and paired Bluetooth stethoscope. Data collected by longitudinal and cross-sectional surveys and chart review before (May 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic were analyzed using descriptive statistics and thematic analysis. RESULTS A total of 258 patients were admitted to the Level II NICU before (May 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic. Demographic characteristics and outcomes, including breastfeeding at discharge and length of stay were similar pre- and postonset of the COVID-19 pandemic. Postrounding surveys by 10 (response rate 83%) neonatologists indicated parents were present in 80 (77%) of rounds and video was at least somewhat helpful in 94% of cases. Cross-sectional survey responses of 23 neonatologists and APPs (response rate 62%) indicated satisfaction with the program. Common themes on qualitative analysis of open-ended survey responses were "need for goodness of fit" and "another set of eyes" and "opportunities for use." CONCLUSION Daily telerounding with neonatologists and APPs in a Level II NICU supported neonatal care. Quality metrics and clinical outcomes are described with no differences seen before and during the COVID-19 pandemic. KEY POINTS · Little is known about Level II NICU quality metrics and outcomes.. · Daily bedside telerounding with neonatologists and APPs is described.. · Telerounding supported neonatal care before and during the COVID-19 pandemic.. · Neonatologists found visual exam helpful in the majority of cases.. · No differences in NICU clinical outcomes were seen during the COVID-19 pandemic..
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Affiliation(s)
- Christine Cooper
- Department of Pediatrics, Neonatology Regional Program, Seattle Children's Hospital, Seattle, Washington
| | - Rossella Mastroianni
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Elena Bosque
- Department of Pediatrics, Neonatology Regional Program, Seattle Children's Hospital, Seattle, Washington
| | - Shilpi Chabra
- Division of Neonatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Julie Campbell
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Jose A Perez
- Division of Neonatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Cailin F White
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Jasmine E James
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Rachel A Umoren
- Division of Neonatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
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2
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Schumacher S, Mitzlaff B, Mohrmann C, Fiedler KM, Heep A, Beske F, Hoffmann F, Lange M. Characteristics and special challenges of neonatal emergency transports. Early Hum Dev 2024; 192:106012. [PMID: 38648678 DOI: 10.1016/j.earlhumdev.2024.106012] [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: 03/02/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND As a rule, newborns do not require special medical care. If unexpected complications occur peripartum or postpartum, support from and transport to specialised neonatal hospitals might be needed. METHODS In a retrospective study, all transport protocols of a supraregional paediatric‑neonatological maximum care hospital in northwestern Germany from 01.10.2018 through 30.09.2021 were analysed. The particular focus was on transports of newborns (<7 days) and the leading symptoms that led to contact. RESULTS A total of 299 patients were included (average age of 15.4 h, 61.6 % males). The average complete transport time was approximately 2 h. Five leading neonatal diseases (respiratory, infectious, asphyxia, cardiac, haematological) were found to represent the causes of >80 % of transfers. Respiratory adaptation disorders are the main reason for transferring a newborn to a centre, whereas asphyxia is the most severe condition. The various symptoms differ in their time of onset, a factor which must be taken into account in practice. Differences were also found between different types of hospitals: while a large proportion of transports were carried out from maternity hospitals (80.6 %), children transported from children's hospitals were generally more severely ill. DISCUSSION Transfers of neonates, especially from maternity hospitals to neonatal intensive care units due to special neonatal diseases, are not rare. In times of increasingly scarce resources, the effective care of sick or at-risk neonates is essential. For low-population regions, this means professional cooperation between maximum care providers and smaller children's hospitals and maternity-only hospitals.
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Affiliation(s)
- S Schumacher
- Department of Pediatrics, Klinikum Leer, Leer, Germany
| | - B Mitzlaff
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - C Mohrmann
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - K M Fiedler
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - A Heep
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - F Beske
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - F Hoffmann
- Department of Healthcare Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - M Lange
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany.
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3
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Jagarapu J, Kapadia V, Mir I, Kakkilaya V, Carlton K, Fokken M, Brown S, Hall-Barrow J, Savani RC. TeleNICU: Extending the reach of level IV care and optimizing the triage of patient transfers. J Telemed Telecare 2024; 30:165-172. [PMID: 34524916 DOI: 10.1177/1357633x211038153] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of telemedicine to provide care for critically ill newborn infants has significantly evolved over the last two decades. Children's Health System of Texas and University of Texas Southwestern Medical Center established TeleNICU, the first teleneonatology program in Texas. OBJECTIVE To evaluate the effectiveness of Tele Neonatal Intensive Care Unit (TeleNICU) in extending quaternary neonatal care to more rural areas of Texas. MATERIALS AND METHODS We conducted a retrospective review of TeleNICU consultations from September 2013 to October 2018. Charts were reviewed for demographic data, reasons for consultation, and consultation outcomes. Diagnoses were classified as medical, surgical, or combined. Consultation outcomes were categorized into transferred or retained. Transport cost savings were estimated based on the distance from the hub site and the costs for ground transportation. RESULTS TeleNICU had one hub (Level IV) and nine spokes (Levels I-III) during the study period. A total of 132 direct consultations were completed during the study period. Most consultations were conducted with Level III units (81%) followed by level I (13%) and level II (6%) units. Some common diagnoses included prematurity (57%), respiratory distress (36%), congenital anomalies (25%), and neonatal surgical emergencies (13%). For all encounters, 54% of the patients were retained at the spoke sites, resulting in an estimated cost savings of USD0.9 million in transport costs alone. The likelihood of retention at spoke sites was significantly higher for medical diagnoses compared to surgical diagnoses (89% vs. 11%). CONCLUSION Telemedicine effectively expands access to quaternary neonatal care for more rural communities, helps in the triage of neonatal transfers, promotes family centered care, and significantly reduces health care costs.
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Affiliation(s)
| | - Vishal Kapadia
- The University of Texas Southwestern Medical Center, USA
| | - Imran Mir
- The University of Texas Southwestern Medical Center, USA
| | | | - Kristin Carlton
- Children's Medical Center of The Children's Health System of Texas, USA
| | - Micky Fokken
- Children's Medical Center of The Children's Health System of Texas, USA
| | | | - Julie Hall-Barrow
- Children's Medical Center of The Children's Health System of Texas, USA
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4
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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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5
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Fang JL, Umoren R, Whyte H, Limjoco J, Makkar A, Yankanah R, McCoy M, Lo MD, Colby CE, Herrin J, Jacobson RM, Demaerschalk BM. Provider Perspectives on the Acceptability, Appropriateness, and Feasibility of Teleneonatology. Am J Perinatol 2023; 40:1521-1528. [PMID: 34583392 DOI: 10.1055/a-1656-6363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aimed to measure provider perspectives on the acceptability, appropriateness, and feasibility of teleneonatology in neonatal intensive care units (NICUs) and community hospitals. STUDY DESIGN Providers from five academic tertiary NICUs and 27 community hospitals were surveyed using validated implementation measures to assess the acceptability, appropriateness, and feasibility of teleneonatology. For each of the 12 statements, scale values ranged from 1 to 5 (1 = strongly disagree; 5 = strongly agree), with higher scores indicating greater positive perceptions. Survey results were summarized, and differences across respondents assessed using generalized linear models. RESULTS The survey response rate was 56% (203/365). Respondents found teleneonatology to be acceptable, appropriate, and feasible. The percent of respondents who agreed with each of the twelve statements ranged from 88.6 to 99.0%, with mean scores of 4.4 to 4.7 and median scores of 4.0 to 5.0. There was no difference in the acceptability, appropriateness, and feasibility of teleneonatology when analyzed by professional role, years of experience in neonatal care, or years of teleneonatology experience. Respondents from Level I well newborn nurseries had greater positive perceptions of teleneonatology than those from Level II special care nurseries. CONCLUSION Providers in tertiary NICUs and community hospitals perceive teleneonatology to be highly acceptable, appropriate, and feasible for their practices. The wide acceptance by providers of all roles and levels of experience likely demonstrates a broad receptiveness to telemedicine as a tool to deliver neonatal care, particularly in rural communities where specialists are unavailable. KEY POINTS · Neonatal care providers perceive teleneonatology to be highly acceptable, appropriate, and feasible.. · Perceptions of teleneonatology do not differ based on professional role or years of experience.. · Perceptions of teleneonatology are especially high in smaller hospitals with well newborn nurseries..
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Affiliation(s)
- Jennifer L Fang
- Division of Neonatal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, University of Washington & Seattle Children's Hospital, Seattle, Washington
| | - Hilary Whyte
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jamie Limjoco
- Division of Neonatology, University of Wisconsin, Madison, Wisconsin
| | - Abhishek Makkar
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Rosanna Yankanah
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike McCoy
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mark D Lo
- Division of Emergency Medicine, Department of Pediatrics, University of Washington & Seattle Children's Hospital, Seattle, Washington
| | - Christopher E Colby
- Division of Neonatal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Jeph Herrin
- Division of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bart M Demaerschalk
- Department of Neurology and Center for Connected Care, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona
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6
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Tankala R, Huang L, Hiskens M, Vangaveti V, Kandasamy Y, Hariharan G. Neonatal retrievals from a regional centre: Outcomes, missed opportunities and barriers to back transfer. J Paediatr Child Health 2023; 59:680-685. [PMID: 36799108 DOI: 10.1111/jpc.16370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/11/2023] [Accepted: 01/29/2023] [Indexed: 02/18/2023]
Abstract
AIM High-risk neonates are retrieved from regional centres to tertiary neonatal units when the required care of the baby exceeds the clinical capabilities of the birthing facility. However, there is limited research on the outcomes of neonatal retrievals from regional special care centres and the barriers to back transfer of neonates from a tertiary centre are not well established. This study aimed to review the outcome of neonatal retrievals >32 weeks gestation from a regional referral centre. The study also aimed to determine missed opportunities for providing care at the regional centre and evaluate patient back transfer delays. METHODS All neonates transferred to a tertiary neonatal intensive care unit in North Queensland over the 5-year period January 2016 to December 2020 from a regional neonatal centre were retrospectively reviewed from the electronic medical records. RESULTS Fifty neonates transferred to a tertiary neonatal intensive care unit over the study period were identified. Between 2016 and 2020, the number of neonatal retrievals increased (P = 0.021). Out of the 50 neonatal retrievals, 86% were for medical reasons. Overall, eight neonates were identified as missed opportunities whose care could have been maintained at the regional centre with support from the tertiary neonatal intensive care unit. In total, 16 neonates were affected by a delay in back transfer. CONCLUSIONS This study shows a significant increase in retrievals to tertiary neonatal intensive care unit over the study period. Increasing bed capacity, utilising telehealth and recruiting regional special care nursery staff could improve outcomes and reduce strain on tertiary neonatal resources.
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Affiliation(s)
- Ravi Tankala
- Department of Paediatrics, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Lee Huang
- Department of Paediatrics, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Matthew Hiskens
- Mackay Institute of Research and Innovation, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Venkat Vangaveti
- School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Yoga Kandasamy
- Neonatal Unit, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Gopakumar Hariharan
- Department of Paediatrics, Mackay Base Hospital, Mackay, Queensland, Australia.,School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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7
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Eckart F, Kaufmann M, Rüdiger M, Birdir C, Mense L. [Telemedical support of feto-neonatal care in one region - Part II: Structural requirements and areas of application in neonatology]. Z Geburtshilfe Neonatol 2023; 227:87-95. [PMID: 36702135 DOI: 10.1055/a-1977-9102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Telemedical infrastructure for patient assessment, care and follow-up as well as interdisciplinary exchange can contribute to ensuring patient care that is close to home and meets the highest quality standards, even outside specialised centres. In neonatology, synchronous audio-visual communication across institutions has been used for many years, especially in the Anglo-American countries. Areas of application include extended neonatal primary care and resuscitation, specific diagnostic applications, e.g. ROP screening and echocardiography, as well as parental care, regular telemedical ward rounds and further training of medical staff, especially using simulation training. For the implementation of such telemedical infrastructures, certain organisational, medical-legal and technical requirements for hardware, software and structural and process organisation must be met. The concrete realisation of a telemedical infrastructure currently being implemented for the region of Eastern Saxony is demonstrated here using the example of the Saxony Center for feto/neonatal Health (SCFNH). Within the framework of feto-neonatal competence networks such as the SCFNH, the quality of medical care, patient safety and satisfaction in a region can be increased by means of a comprehensive, well-structured and established telemedical infrastructure.
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Affiliation(s)
- Falk Eckart
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Fachbereich Neonatologie & Pädiatrische Intensivmedizin, Medizinische Fakultät, TU Dresden, Dresden, Germany.,Zentrum für Feto/Neonatale Gesundheit, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Maxi Kaufmann
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Fachbereich Neonatologie & Pädiatrische Intensivmedizin, Medizinische Fakultät, TU Dresden, Dresden, Germany.,Zentrum für Feto/Neonatale Gesundheit, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Mario Rüdiger
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Fachbereich Neonatologie & Pädiatrische Intensivmedizin, Medizinische Fakultät, TU Dresden, Dresden, Germany.,Zentrum für Feto/Neonatale Gesundheit, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Cahit Birdir
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Medizinische Fakultät, TU Dresden, Dresden, Germany.,Zentrum für Feto/Neonatale Gesundheit, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Lars Mense
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Fachbereich Neonatologie & Pädiatrische Intensivmedizin, Medizinische Fakultät, TU Dresden, Dresden, Germany.,Zentrum für Feto/Neonatale Gesundheit, Medizinische Fakultät, TU Dresden, Dresden, Germany
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8
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Thao V, Dholakia R, Kreofsky BL, Moriarty JP, Colby CE, Demaerschalk BM, Borah BJ, Fang JL. Modeling the Cost of Teleneonatology from the Health System Perspective. Telemed J E Health 2022; 28:1464-1469. [PMID: 35235430 DOI: 10.1089/tmj.2021.0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Teleneonatology (TN) allows remote neonatologists to provide real-time audio-video telemedicine support to community hospitals when neonates require advanced resuscitation or critical care. Currently, there are no published economic evaluations of U.S. TN programs. Objective: To evaluate the cost of TN from the perspective of the health care system. Methods: We constructed a decision tree comparing TN to usual care for neonates born in hospitals without a neonatal intensive care unit (NICU) who require consultation. Our outcome of interest was total cost per patient, which included the incremental cost of a TN program, the cost of medical transport, and the cost of NICU or non-NICU hospitalization. We performed threshold sensitivity analyses where we varied each parameter to determine whether the base-case finding reverted. Results: For neonates requiring consultation after birth in a hospital without a NICU, TN was less costly ($16,878) than usual care ($28,047), representing a cost-savings of $11,168 per patient. Sensitivity analyses demonstrated that at least one of the following conditions would need to be met for TN to no longer be cost saving compared to usual care: transfer rate with usual care <12% (base-case = 82%), TN reducing the odds of transfer by <8% (base-case = 52%), or TN cost exceeding $12,989 per patient (base-case = $1,821 per patient). Conclusions: Economic modeling from the health system perspective demonstrated that TN was cost saving compared to usual care for neonates requiring consultation following delivery in a non-NICU hospital. Understanding the cost savings associated with TN may influence organizational decisions regarding implementation, diffusion, and retention of these programs.
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Affiliation(s)
- Viengneesee Thao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ruchita Dholakia
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Beth L Kreofsky
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - James P Moriarty
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Bart M Demaerschalk
- Department of Neurology and Center for Digital Health, Mayo Clinic, Scottsdale, Arizona, USA
| | - Bijan J Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L Fang
- Division of Neonatal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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9
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Miller M, Delaney K, Lustik M, Nguyen C, Jones M, Mbuthia J. Updated Review of the Pacific Asynchronous Telehealth System's Impact on Military Pediatric Teleconsultations. Telemed J E Health 2022; 28:1009-1015. [PMID: 34981971 DOI: 10.1089/tmj.2021.0279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The Pacific Asynchronous TeleHealth (PATH) system is an asynchronous provider-to-provider teleconsultation platform utilized by military medical facilities throughout the Western Pacific Region. This study focused on PATH utilization for pediatric cases and its impact on patient transfers and cost avoidance. Methods: This retrospective analysis reviewed PATH cases from March 2017 to February 2020 for patients aged 0-17 years. We reviewed the referring users' responses to survey questions related to the impact of PATH consultation on patient travel for in-person subspecialty care and the need for local referral. Data for cost avoidance were estimated using per diem rates and airline flight costs for Fiscal Year 2020. Results: A total of 2,448 pediatric consultations were submitted from 29 military medical facilities. Pediatric Pulmonology (n = 557, 24.5%), Pediatric Cardiology (n = 446, 19.6%), and Pediatric Neurology (n = 236, 10.37%) had the highest percentage of pediatric teleconsults. Approximately 42% of referring users completed the survey questions. Among survey respondents, 710 (69.4%) indicated that unnecessary patient transfers were prevented, equating to a cost savings of ∼$3.3 million. Conclusions: We observed robust utilization of the PATH system by pediatric providers in the Military Health System that ultimately resulted in substantial cost avoidance. This asynchronous telemedicine platform is a vital asset in locations with limited access or travel restriction to medical specialists, such as during pandemics.
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Affiliation(s)
- Mechelle Miller
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii
| | - Kara Delaney
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii
| | - Michael Lustik
- Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii
| | - Charles Nguyen
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii
| | - Milissa Jones
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii.,Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Jennifer Mbuthia
- Department of Clinical Informatics, The Queen's Medical Center, Clinical Informatics, Honolulu, Hawaii
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10
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Coffey R, Melendi M, Cutler AK, Craig AK. Telemedicine Consultation to Assess Neonatal Encephalopathy in Rural Community Hospitals and Tertiary Care Centers. JOURNAL OF MAINE MEDICAL CENTER 2022; 4:7. [PMID: 36277501 PMCID: PMC9586178 DOI: 10.46804/2641-2225.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Teleconsultation is used in tertiary care hospitals to evaluate neonatal encephalopathy. Neonates born in community hospitals, however, often experience delayed evaluation due to transport to the tertiary care center. We studied teleconsultations in community hospitals to decrease this disparity. METHODS Prospective observational study in 9 community hospitals and 1 neonatal intensive care unit. Inclusion criteria: gestational age greater than or equal to 35 weeks and one of the following: umbilical cord pH less than or equal to 7.2, 5-minute Apgar less than 7, prolonged respiratory support, perinatal event, or abnormal neurological exam. We performed synchronized, unscheduled telemedicine consults with the main outcome of time to teleconsultation. RESULTS From April 2018 to September 2020, we performed 53 teleconsultations: 34 (64%) in community hospitals and 19 (36%) in the tertiary care center. Teleconsultations occurred at a median of 98 minutes (IQR, 76-127) in community hospitals versus 68 minutes (IQR, 43-91) in the tertiary care center (p = .004). Nine (26%) neonates born in a community hospital remained with their parents and were not transferred to the tertiary care center for further assessment. DISCUSSION Neonates born in rural community hospitals have slightly later teleconsultations than neonates born in the tertiary care center. Telemedicine use reduced this disparity from nearly 5 hours in our prior study to 98 minutes in this study by permitting evaluation of neonates in community hospitals without transporting them to the tertiary care center. CONCLUSIONS Teleconsultations to evaluate neonatal encephalopathy are a feasible, accessible, and reliable way to bring expert-level care into rural community hospitals.
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Affiliation(s)
- Rachel Coffey
- Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME
| | - Misty Melendi
- Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME
- Division of Neonatology, Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME
| | - Anya K Cutler
- Center for Outcomes Research, Maine Medical Center, Portland, ME
| | - Alexa K Craig
- Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME
- Division of Pediatric Neurology, Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME
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11
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Smith AC, Armfield NR, Coulthard MG, Williams ML, Caffery LJ. Queensland Telepaediatric Service: A Review of the First 15 Years of Service. Front Digit Health 2021; 2:587452. [PMID: 34713059 PMCID: PMC8521862 DOI: 10.3389/fdgth.2020.587452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022] Open
Abstract
In November 2000, the Queensland Telepaediatric Service (QTS) was established in Brisbane, Australia, to support the delivery of telehealth services to patients and clinicians in regional and remote locations. The QTS was built on a centralized coordination model, where telehealth services could be effectively managed by a dedicated telehealth coordinator. In doing so, telehealth referral and consultation processes were efficient and clinicians felt better supported as they adjusted to new processes for engaging with patients. We have conducted a retrospective review of activity associated with the QTS and summarized key activities which have arisen from this extensive program of work. Telehealth service records and associated publications were used to describe the evolution of the QTS over a 15-year period. From November 2000 to March 2016, 23,054 telehealth consultations were delivered for 37 pediatric clinical specialties. The most common service areas included child and youth mental health, neurology, burns care, surgery, and ear nose and throat services. A range of different telehealth service models were developed to align with different clinical service needs and location of services. Whilst most work involved video consultation between hospitals, some services involved the delivery of telehealth services into the home, schools or community health centres. Despite its longevity, the QTS was not immune to the usual challenges associated with telehealth implementation, service redesign and sustainability. Experience reported from the QTS will be useful for other health services seeking to develop comprehensive telehealth services in a rapidly changing healthcare environment.
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Affiliation(s)
- Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.,Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
| | - Nigel R Armfield
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.,Recover Injury Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Mark G Coulthard
- Pediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.,Mayne Academy of Pediatrics, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
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12
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Fang JL, Umoren R, Whyte H, Limjoco J, Makkar A, Yankanah R, McCoy M, Lo MD, Colby CE, Herrin J, Jacobson RM, Demaerschalk BM. Provider Perspectives on the Acceptability, Appropriateness, and Feasibility of Teleneonatology. Am J Perinatol 2021. [PMID: 34666395 DOI: 10.1055/s-0041-1736587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aimed to measure provider perspectives on the acceptability, appropriateness, and feasibility of teleneonatology in neonatal intensive care units (NICUs) and community hospitals. STUDY DESIGN Providers from five academic tertiary NICUs and 27 community hospitals were surveyed using validated implementation measures to assess the acceptability, appropriateness, and feasibility of teleneonatology. For each of the 12 statements, scale values ranged from 1 to 5 (1 = strongly disagree; 5 = strongly agree), with higher scores indicating greater positive perceptions. Survey results were summarized, and differences across respondents assessed using generalized linear models. RESULTS The survey response rate was 56% (203/365). Respondents found teleneonatology to be acceptable, appropriate, and feasible. The percent of respondents who agreed with each of the twelve statements ranged from 88.6 to 99.0%, with mean scores of 4.4 to 4.7 and median scores of 4.0 to 5.0. There was no difference in the acceptability, appropriateness, and feasibility of teleneonatology when analyzed by professional role, years of experience in neonatal care, or years of teleneonatology experience. Respondents from Level I well newborn nurseries had greater positive perceptions of teleneonatology than those from Level II special care nurseries. CONCLUSION Providers in tertiary NICUs and community hospitals perceive teleneonatology to be highly acceptable, appropriate, and feasible for their practices. The wide acceptance by providers of all roles and levels of experience likely demonstrates a broad receptiveness to telemedicine as a tool to deliver neonatal care, particularly in rural communities where specialists are unavailable. KEY POINTS · Neonatal care providers perceive teleneonatology to be highly acceptable, appropriate, and feasible.. · Perceptions of teleneonatology do not differ based on professional role or years of experience.. · Perceptions of teleneonatology are especially high in smaller hospitals with well newborn nurseries..
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Affiliation(s)
- Jennifer L. Fang
- Division of Neonatal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, University of Washington & Seattle Children's Hospital, Seattle, Washington
| | - Hilary Whyte
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jamie Limjoco
- Division of Neonatology, University of Wisconsin, Madison, WI
| | - Abhishek Makkar
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Rosanna Yankanah
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike McCoy
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mark D. Lo
- Division of Emergency Medicine, Department of Pediatrics, University of Washington & Seattle Children's Hospital, Seattle, Washington
| | - Christopher E. Colby
- Division of Neonatal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Jeph Herrin
- Division of Cardiovascular Medicine, Yale School of Medicine, New Haven Connecticut
| | - Robert M. Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bart M. Demaerschalk
- Department of Neurology and Center for Connected Care, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona
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13
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Arnaez J, Vega-Del-Val C, Hortigüela M, Benavente-Fernández I, Martínez-Biarge M, Ochoa Sangrador C, Garcia-Alix A. Usefulness of video recordings for validating neonatal encephalopathy exams: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2021; 106:522-528. [PMID: 33597228 DOI: 10.1136/archdischild-2020-320791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the usefulness of video recordings for validating neonatal encephalopathy (NE) exams. DESIGN Population-based prospective cohort study. NE was assessed and recorded at 1, 3 and 5 hours after birth by the attending physician. Recordings were reviewed blindly after the recruitment period by two specialists. Outcome was assessed at 36 months of age. SETTING Twelve intensive care units in Spain. PATIENTS Infants of ≥35 weeks' gestational age with perinatal asphyxia. MAIN OUTCOMES MEASURES Weighted kappa to measure disagreement between the two specialists and between the attending physician and the specialists' classification agreed on by consensus. Regression models to test the association of disagreement on NE assessment and outcome. RESULTS Of the 32 325 liveborn infants, 217 met the inclusion criteria. Video-recordings were not available for 43 infants (20%). Weighted kappa statistic was 0.74 (95% CI 0.67 to 0.81) between the specialists and the attending physicians. Disagreement occurred in 93 of the 417 (22%) videos, specifically in 39 (14%), 43 (47%), 11 (34%) and 0 exams categorised as no, mild, moderate and severe NE, respectively. According to the specialist consensus assessment, there was disagreement on the therapeutic hypothermia decision in 10 infants.When there was consensus among the specialists assessing a more severe NE degree compared with the attending physicians in 170 infants, those infants had lower cognitive scores with a median of -5.33 points (95% CI -9.85 to -8.16; p=0.02). CONCLUSIONS This study supports the feasibility and benefit of using video recordings to identify NE in infants with perinatal asphyxia.
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Affiliation(s)
- Juan Arnaez
- Neonatology, Hospital Universitario de Burgos, Burgos, Spain .,NeNe Foundation, Madrid, Spain
| | | | | | - Isabel Benavente-Fernández
- NeNe Foundation, Madrid, Spain.,Neonatology, Puerta del Mar Universtity Hospital, Cadiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.,Area of Paediatrics, Department of Child and Mother Health and Radiology, Faculty of Medicine, University of Cádiz, Cádiz, Spain
| | | | | | - Alfredo Garcia-Alix
- NeNe Foundation, Madrid, Spain.,Institut de Recerca Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
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14
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Abstract
Neonatal tele-resuscitation programs use synchronous audio-video telemedicine systems to connect neonatologists with community hospital care teams during high risk resuscitations. Using tele-resuscitation, remote neonatologists can visualize and actively guide the resuscitation and stabilization of at-risk neonates. The feasibility of tele-resuscitation has been proven, and early evidence suggests that tele-resuscitation improves the quality of care, reduces unnecessary medical transports, and may generate a net savings to the health system. Community hospital staff and remote neonatologists are highly satisfied with tele-resuscitation programs. Tele-resuscitation presents an opportunity to improve healthcare delivery for neonates regardless of their birth location. The neonatology community should work to identify and rigorously study the value tele-resuscitation can bring to neonates, their families, and care teams.
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Affiliation(s)
- Jennifer L Fang
- Division of Neonatal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
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15
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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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16
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Craig AK, McAllister LM, Evans S, Melendi ME. Telemedicine consults to assess neonatal encephalopathy are feasible in the neonatal intensive care unit. J Perinatol 2021; 41:1519-1521. [PMID: 32958837 PMCID: PMC8593849 DOI: 10.1038/s41372-020-00828-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/14/2020] [Accepted: 09/10/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Alexa K. Craig
- Maine Medical Center, Department of Pediatrics, Division of Pediatric Neurology Portland, Maine
| | | | - Scott Evans
- Maine Medical Center, Department of Pediatrics, Division of Neonatology, Portland, Maine
| | - Misty E. Melendi
- Maine Medical Center, Department of Pediatrics, Division of Neonatology, Portland, Maine
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17
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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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18
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The COVID-19 Pandemic and Rapid Implementation of Adolescent and Young Adult Telemedicine: Challenges and Opportunities for Innovation. J Adolesc Health 2020; 67:164-171. [PMID: 32410810 PMCID: PMC7221366 DOI: 10.1016/j.jadohealth.2020.05.006] [Citation(s) in RCA: 226] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 12/04/2022]
Abstract
PURPOSE This study describes the rapid implementation of telemedicine within an adolescent and young adult (AYA) medicine clinic in response to the Coronavirus Disease 2019 (COVID-19) pandemic. While there are no practice guidelines specific to AYA telemedicine, observations made during this implementation can highlight challenges encountered and suggest solutions to some of these challenges. METHODS Over the course of several weeks in March, 2020, the Adolescent and Young Adult Medicine Clinic at the University of California San Francisco rapidly replaced most in-person visits with telemedicine visits. This required logistical problem-solving, collaboration of all clinic staff members, and continuous reassessment of clinical practices. This article describes observations made during these processes. RESULTS Telemedicine visits increased from zero to 97% of patient encounters in one month. The number of visits per month was comparable with that one year prior. While there were limitations to the clinic's ability to carry out health supervision visits, many general health, mental health, reproductive health, eating disorders, and addiction treatment services were implemented via telemedicine. Providers identified creative solutions for challenges that arose to managing general confidentiality issues as well as specific challenges related to mental health, reproductive health, eating disorders, and addiction care. Opportunities to implement and expand high-quality AYA telemedicine were also identified. CONCLUSIONS The COVID-19 pandemic is leading to widespread telemedicine implementation. While telemedicine seems to be feasible and acceptable for our clinic patients, unanswered questions remain regarding confidentiality, quality of care, and health disparities. Clinical guidelines are also needed to guide best practices for telemedicine in this patient population.
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19
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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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20
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Telehealth for Pediatric Cardiology Practitioners in the Time of COVID-19. Pediatr Cardiol 2020; 41:1081-1091. [PMID: 32656626 PMCID: PMC7354365 DOI: 10.1007/s00246-020-02411-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/03/2020] [Indexed: 01/18/2023]
Abstract
Due to the COVID-19 pandemic, there has been an increased interest in telehealth as a means of providing care for children by a pediatric cardiologist. In this article, we provide an overview of telehealth utilization as an extension of current pediatric cardiology practices and provide some insight into the rapid shift made to quickly implement these telehealth services into our everyday practices due to COVID-19 personal distancing requirements. Our panel will review helpful tips into the selection of appropriate patient populations and specific cardiac diagnoses for telehealth that put patient and family safety concerns first. Numerous practical considerations in conducting a telehealth visit must be taken into account to ensure optimal use of this technology. The use of adapted staffing and billing models and expanded means of remote monitoring will aid in the incorporation of telehealth into more widespread pediatric cardiology practice. Future directions to sustain this platform include the refinement of telehealth care strategies, defining best practices, including telehealth in the fellowship curriculum and continuing advocacy for technology.
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21
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Couturier K, Whitfill T, Bhatnagar A, Panchal RA, Parker J, Wong AH, Bruno CJ, Auerbach MA, Gross IT. Impact of telemedicine on neonatal resuscitation in the emergency department: a simulation-based randomised trial. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2019; 6:10-14. [PMID: 35514445 DOI: 10.1136/bmjstel-2018-000398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2018] [Indexed: 11/04/2022]
Abstract
Background The delivery and initial resuscitation of a newborn infant are required but rarely practised skills in emergency medicine. Deliveries in the emergency department are high-risk events and deviations from best practices are associated with poor outcomes. Introduction Telemedicine can provide emergency medicine providers real-time access to a Neonatal Resuscitation Program (NRP)-trained paediatric specialist. We hypothesised that adherence to NRP guidelines would be higher for participants with access to a remotely located NRP-trained paediatric specialist via telemedicine compared with participants without access. Materials and methods Prospective single-centre randomised trial. Emergency Medicine residents were randomised into a telemedicine or standard care group. The participants resuscitated a simulated, apnoeic and bradycardic neonate. In the telemedicine group a remote paediatric specialist participated in the resuscitation. Simulations were video recorded and assessed for adherence to guidelines using four critical actions. The secondary outcome of task load was measured through participants' completion of the NASA Task Load Index (NASA-TLX) and reviewers completed a detailed NRP checklist. Results Twelve participants were included. The use of telemedicine was associated with significantly improved adherence to three of the four critical actions reflecting NRP guidelines as well as a significant improvement in the overall score (p<0.001). On the NASA-TLX, no significant difference was seen in overall subjective workload assessment, but of the subscore components, frustration was statistically significantly greater in the control group (p<0.001). Conclusions In this study, telemedicine improved adherence to NRP guidelines. Future work is needed to replicate these findings in the clinical environment.
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Affiliation(s)
- Katherine Couturier
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Travis Whitfill
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ambika Bhatnagar
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rajavee A Panchal
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John Parker
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christie J Bruno
- Department of Neonatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marc A Auerbach
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Isabel T Gross
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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22
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Hoffman AM, Lapcharoensap W, Huynh T, Lund K. Historical Perspectives: Telemedicine in Neonatology. Neoreviews 2019; 20:e113-e123. [PMID: 31261049 DOI: 10.1542/neo.20-3-e113] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Telemedicine is fast becoming integrated into health care as a way to increase access for patients, particularly across the urban/rural divide. Use of telemedicine in neonatology is a newer, yet rapidly expanding modality. This review outlines the history of telemedicine, the evolution of its current uses in neonatology, requirements for starting a telemedicine program, and potential future uses.
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Affiliation(s)
- Amber M Hoffman
- Department of Telehealth Services, Oregon Health & Science University, Portland, OR
| | - Wannasiri Lapcharoensap
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Trang Huynh
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Kelli Lund
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
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23
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Asiedu GB, Fang JL, Harris AM, Colby CE, Carroll K. Health Care Professionals' Perspectives on Teleneonatology Through the Lens of Normalization Process Theory. Health Sci Rep 2019; 2:e111. [PMID: 30809596 PMCID: PMC6375543 DOI: 10.1002/hsr2.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/05/2018] [Accepted: 12/11/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND AND AIMS Little research has been done on tele-intensive care unit (ICU) implementation across different types of ICUs, and there exist few studies that have used qualitative research methods to analyze the human and organizational factors influencing optimization of telemedicine for newborn resuscitation. The objective of this study was to understand health care professionals' acceptance, utilization, and integration of video telemedicine for newborn resuscitation (termed teleneonatology) in community hospital settings. METHODS Focus group and individual interviews were conducted with 49 health care professionals at six affiliated health system hospitals. Data were gathered from physicians (n = 18), nurses (n = 30), and a nurse practitioner. Data were inductively analyzed using a thematic approach, and then constructs from normalization process theory (NPT) were deductively applied. NPT rendered a general framework to describe and assess how care teams perceive the implementation of teleneonatology and how they interact with this telemedicine service in their local setting. RESULTS Local health care professionals accepted teleneonatology as an important, helpful service, yet its implementation was perceived as both valuable and a threat to professional traditions. Utilization may depend on perceived benefit, mutual understanding of the guidelines, and expectations of use, and other relational, human, contextual, and system factors. Participants in this study agreed on the need for collective work to successfully integrate teleneonatology into the local practice. DISCUSSIONS NPT uncovered that successful implementation of a teleneonatology program may be facilitated by strong interpersonal relationships among care teams, continuous programmatic training and education, and communicating the clinical value of teleneonatology, including its opportunities and benefits.
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Affiliation(s)
- Gladys B. Asiedu
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo Clinic RochesterMinnesota
| | | | - Ann M. Harris
- Department of Health Sciences Research Mayo ClinicRochesterMinnesota
| | | | - Katherine Carroll
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo Clinic RochesterMinnesota
- School of Sociology, College of Arts and Social SciencesAustralian National UniversityCanberraAustralia
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Bele S, Cassidy C, Curran J, Johnson DW, Saunders C, Bailey JAM. Barriers and enablers to implementing a virtual tertiary-regional Telemedicine Rounding and Consultation (TRAC) model of inpatient pediatric care using the Theoretical Domains Framework (TDF) approach: a study protocol. BMC Health Serv Res 2019; 19:29. [PMID: 30634969 PMCID: PMC6330415 DOI: 10.1186/s12913-018-3859-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022] Open
Abstract
Background Over-occupancy at the two tertiary pediatric care hospitals in Alberta, Canada is steadily increasing with simultaneous decline in occupancy of pediatric beds at regional hospitals. Over-occupancy negatively impacts timeliness and potentially, the safety of patient care provided at these two tertiary hospitals. In contrast, underutilization of pediatric beds at regional hospitals poses the risk of losing beds provincially, dilution of regional pediatric expertise and potential erosion of confidence by regional providers. One approach to the current situation in provincial pediatric care capacity is development of telemedicine based innovative models of care that increase the population of patients cared for in regional pediatric beds. A Telemedicine Rounding and Consultation (TRAC) model involves discussing patient care or aspects of their care using telemedicine by employing visual displays, audio and information sharing between tertiary and regional hospitals. To facilitate implementation of a TRAC model, it is essential to understand the perceived barriers among its potential users in local context. The current study utilizes qualitative methodologies to assess these perceived clinician barriers to inform a future pilot and evaluation of this innovative virtual pediatric tertiary-regional collaborative care model in Alberta. Methods We will use a qualitative descriptive design guided by the Theoretical Domain Framework (TDF) to systematically identify the tertiary and regional clinical stakeholder’s perceived barriers and enablers to the implementation of proposed TRAC model of inpatient pediatric care. Semi-structured interviews and focus groups with pediatricians, nurses and allied health professionals, administrators, and family members will be conducted to identify key barriers and enablers to implementation of the TRAC model using TDF. Appropriate behaviour change techniques will be identified to develop potential intervention strategies to overcome identified barriers. These intervention strategies will facilitate implementation of the TRAC model during the pilot phase. Discussion The proposed TRAC model has the potential to address the imbalance between utilization of regional and tertiary inpatient pediatric facilities in Alberta. Knowledge generated regarding barriers and enablers to the TRAC model and the process outlined in this study could be used by health services researchers to develop similar telemedicine-based interventions in Canada and other parts of the world. Electronic supplementary material The online version of this article (10.1186/s12913-018-3859-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sumedh Bele
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Janet Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - David W Johnson
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Chad Saunders
- Haskayne School of Business, University of Calgary, Calgary, AB, Canada
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Sauers-Ford HS, Marcin JP, Underwood MA, Kim JH, Nicolau Y, Uy C, Chen ST, Hoffman KR. The Use of Telemedicine to Address Disparities in Access to Specialist Care for Neonates. Telemed J E Health 2018; 25:775-780. [PMID: 30394853 DOI: 10.1089/tmj.2018.0095] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Outcomes for premature and critically ill neonates are improved with care provided by neonatologists in a neonatal intensive care unit (NICU). For smaller hospitals, maintaining the personnel and equipment necessary for the delivery and care of unexpectedly high-risk neonates is a significant challenge. To address this disparity in access, telemedicine has been increasingly used to support providers, patients, and their families in community newborn nurseries and NICUs. The purpose of this review is to present the current state of the use of telemedicine by regional NICUs to support community newborn nurseries, NICUs, and families. Methods: A literature review was conducted by two independent reviewers. Articles were selected for inclusion if they described the use of telemedicine with neonates or in the NICU. Two reviewers assessed the quality of the articles using the National Heart, Lung, and Blood Institute Study Quality Assessment Tools. Results: Fourteen articles were identified. After consensus discussion, eight of the articles were rated good and six were rated fair by the two reviewers. Many of the articles suggested improvements in quality of care, family satisfaction, and reductions in the cost of care. Unfortunately, a majority of the studies to date have had small sample sizes or were performed in a single institution and lacked robust evaluations of patient- and family-centered outcomes and provider decision making. Conclusions: While these early studies are promising, more robust studies involving more patients and more institutions are needed to identify opportunities where telemedicine can impact health outcomes, patient-centeredness, or costs of care of neonates.
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Affiliation(s)
- Hadley S Sauers-Ford
- Department of Pediatrics, University of California-Davis, Sacramento, California
| | - James P Marcin
- Department of Pediatrics, University of California-Davis, Sacramento, California
| | - Mark A Underwood
- Department of Pediatrics, University of California-Davis, Sacramento, California
| | - Jae H Kim
- Department of Pediatrics, University of California-San Diego, San Diego, California
| | - Yona Nicolau
- Department of Pediatrics, University of California-Irvine, Irvine, California
| | - Cherry Uy
- Department of Pediatrics, University of California-Irvine, Irvine, California
| | - Shelby T Chen
- Department of Pediatrics, University of California-Davis, Sacramento, California
| | - Kristin R Hoffman
- Department of Pediatrics, University of California-Davis, Sacramento, California
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Satou GM, Rheuban K, Alverson D, Lewin M, Mahnke C, Marcin J, Martin GR, Mazur LS, Sahn DJ, Shah S, Tuckson R, Webb CL, Sable CA. Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e648-e678. [PMID: 28193604 DOI: 10.1161/cir.0000000000000478] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Maintaining high levels of readiness for neonatal resuscitation in low-risk maternity settings is challenging. The neonatal resuscitation program (NRP) algorithm is a community standard in the United States; yet training is biannual, and exposure to enough critical events to be proficient at timely implementation of the algorithm and the advanced procedures is rare. Evidence supports hands-free leadership to help prevent task saturation and communication to promote patient safety. Telemedicine for neonatal resuscitation involves the addition of remote, expert NRP leadership (a NICU-based neonatal nurse practitioner) via camera link to augment effectiveness of the low-risk birth center team. Unanticipated outcomes to report include faster times to transfer initiation and neuroprotective cooling. The positive impact of remote NRP leadership could lead to use of telemedicine to support teams at birthing centers throughout the United States as well as around the world.
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Deldar K, Bahaadinbeigy K, Tara SM. Teleconsultation and Clinical Decision Making: a Systematic Review. Acta Inform Med 2016; 24:286-292. [PMID: 27708494 PMCID: PMC5037984 DOI: 10.5455/aim.2016.24.286-292] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/15/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The goal of teleconsultation is to omit geographical and functional distance between two or more geographically separated health care providers. The purpose of present study is to review and analyze physician-physician teleconsultations. METHOD The PubMed electronic database was searched. The primary search was done on January 2015 and was updated on December 2015. A fetch and tag plan was designed by the researchers using an online Zotero library. RESULTS 174 full-text articles of 1702 records met inclusion criteria. Teleconsultation for pediatric patients accounts for 14.36 percent of accepted articles. Surgery and general medicine were the most prevalent medical fields in the adults and pediatrics, respectively. Most teleconsultations were inland experiences (no=135), and the USA, Italy and Australia were the three top countries in this group. Non-specialists health care providers/centers were the dominant group who requested teleconsultation (no=130). Real time, store and forward, and hybrid technologies were used in 50, 31, and 16.7 percent of articles, respectively. The teleconsultation were reported to result in change in treatment plan, referral or evacuation rate, change in diagnosis, educational effects, and rapid decision making. Use of structured or semi-structured template had been noticed only in a very few articles. CONCLUSION The present study focused on the recent ten years of published articles on physician-physician teleconsultations. Our findings showed that although there are positive impacts of teleconsultation as improving patient management, still have gaps that need to be repaired.
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Affiliation(s)
- Kolsoum Deldar
- Student Research Committee, Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran
| | - Seyed Mahmood Tara
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Abstract
Telemedicine technologies involve real-time, live, interactive video and audio communication and allow pediatric critical care physicians to have a virtual presence at the bedsides of critically ill children. Telemedicine use is increasing and will be a common in remote emergency departments, inpatient wards, and intensive care units for pediatric care. Hospitals and physicians that use telemedicine technologies provide higher quality of care, are more efficient in resource use with improved cost-effectiveness, and have higher satisfaction among patients, parents, and remote providers. More research will result in improved access to pediatric critical care expertise.
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Yang NH, Dharmar M, Yoo BK, Leigh JP, Kuppermann N, Romano PS, Nesbitt TS, Marcin JP. Economic Evaluation of Pediatric Telemedicine Consultations to Rural Emergency Departments. Med Decis Making 2015; 35:773-783. [PMID: 25952744 PMCID: PMC9727838 DOI: 10.1177/0272989x15584916] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 03/13/2015] [Indexed: 11/04/2023]
Abstract
BACKGROUND Comprehensive economic evaluations have not been conducted on telemedicine consultations to children in rural emergency departments (EDs). OBJECTIVE We conducted an economic evaluation to estimate the cost, effectiveness, and return on investment (ROI) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospective. METHODS We built a decision model with parameters from primary programmatic data, national data, and the literature. We performed a base-case cost-effectiveness analysis (CEA), a probabilistic CEA with Monte Carlo simulation, and ROI estimation when CEA suggested cost-saving. The CEA was based on program effectiveness, derived from transfer decisions following telemedicine and telephone consultations. RESULTS The average cost for a telemedicine consultation was $3641 per child/ED/year in 2013 US dollars. Telemedicine consultations resulted in 31% fewer patient transfers compared with telephone consultations and a cost reduction of $4662 per child/ED/year. Our probabilistic CEA demonstrated telemedicine consultations were less costly than telephone consultations in 57% of simulation iterations. The ROI was calculated to be 1.28 ($4662/$3641) from the base-case analysis and estimated to be 1.96 from the probabilistic analysis, suggesting a $1.96 return for each dollar invested in telemedicine. Treating 10 acutely ill and injured children at each rural ED with telemedicine resulted in an annual cost-savings of $46,620 per ED. LIMITATIONS Telephone and telemedicine consultations were not randomly assigned, potentially resulting in biased results. CONCLUSIONS From a health care payer perspective, telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving (base-case and more than half of Monte Carlo simulation iterations) or cost-effective compared with telephone consultations.
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Affiliation(s)
- Nikki H Yang
- Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
| | - Madan Dharmar
- Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
| | - Byung-Kwang Yoo
- Department of Public Health Sciences, University of California, Davis, CA, USA (BKY, JPL)
| | - J Paul Leigh
- Department of Public Health Sciences, University of California, Davis, CA, USA (BKY, JPL)
| | - Nathan Kuppermann
- Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
- Department of Emergency Medicine, University of California, Davis, CA, USA (NK)
| | - Patrick S Romano
- Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
- Department of Internal Medicine, University of California, Davis, CA, USA (PSR)
| | - Thomas S Nesbitt
- Department of Family Practice and Community Medicine, University of California, Davis, CA, USA (TSN)
| | - James P Marcin
- Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
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Kulkarni R, Mauser-Bunschoten EP, Stedman C, Street A. Medical co-morbidities and practice. Haemophilia 2014; 20 Suppl 4:130-6. [PMID: 24762288 DOI: 10.1111/hae.12403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 11/28/2022]
Abstract
All-oral treatments of hepatitis C (HCV) have been trialled in patients with hereditary bleeding disorders and found to be effective. Further refinements of dosing and duration are being established. Importantly for patient acceptability these regimens are interferon-free. Cohort studies in older patients with haemophilia direct the need for attention to weight control, exercice, assessment of cardiovascular risk, especially hypertension and detection of osteoporosis. Where patients live a long way from a comprehensive care centre, telemedicine connections can engage centre experts with the patient and his/her local practitioners in devising and monitoring care plans.
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Affiliation(s)
- R Kulkarni
- Professor and Director Pediatric Hematology/Oncology, Michigan State University, East Lansing, MI, USA
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Armfield NR, Edirippulige SK, Bradford N, Smith AC. Telemedicine--is the cart being put before the horse? Med J Aust 2014; 200:530-3. [PMID: 24835716 DOI: 10.5694/mja13.11101] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 12/17/2013] [Indexed: 12/30/2022]
Abstract
A large literature base on telemedicine exists, but the evidence base for telemedicine is very limited. There is little practical or useful information to guide clinicians and health policymakers. Telemedicine is often implemented based on limited or no prior formal analysis of its appropriateness to the circumstances, and adoption of telemedicine by clinicians has been slow and patchy. Formal analysis should be conducted before implementation of telemedicine to identify the patients, conditions and settings that it is likely to benefit. Primary studies of telemedicine tend to be of insufficient quality to enable synthesis of formal evidence. Methods typically used to assess effectiveness in medicine are often difficult, expensive or impractical to apply to telemedicine. Formal studies of telemedicine should examine efficacy, effectiveness, economics and clinician preferences. Successful adoption and sustainable integration of telemedicine into routine care could be improved by evidence-based implementation.
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Affiliation(s)
- Nigel R Armfield
- Centre for Online Health, School of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Sisira K Edirippulige
- Centre for Online Health, School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Natalie Bradford
- Centre for Online Health, School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Anthony C Smith
- Centre for Online Health, School of Medicine, University of Queensland, Brisbane, QLD, Australia
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Telemedicine for genetic and neurologic evaluation in the neonatal intensive care unit. J Perinatol 2014; 34:234-40. [PMID: 24406740 PMCID: PMC3943754 DOI: 10.1038/jp.2013.159] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/27/2013] [Accepted: 11/06/2013] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Evaluate whether telemedicine can be used to perform dysmorphology and neurologic examinations in the neonatal intensive care unit (NICU) by determining the examination accuracy, limitations and optimized procedures. STUDY DESIGN Prospective evaluation of NICU patients referred for subspecialty consultation for dysmorphic features (n=10) or encephalopathy (n=10). A physician at bedside (bedside clinician) performed an in-person examination that was viewed in real time by a remote physician (remote consultant). Standardized examinations were recorded and compared. Subsequently, a qualitative approach established technique adjustments and optimization procedures necessary to improve visualization. RESULT Telemedicine examinations identified 81 of 87 (93%) dysmorphology examination abnormalities and 37 of 39 (92%) neurologic examination abnormalities. Optimization of remote consultant visualization required an active bedside clinician assisting in camera and patient adjustments. CONCLUSION Telemedicine can be used to perform accurately many components of the dysmorphology or neurologic examinations in NICU patients, but physicians must be mindful of specific limitations.
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