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Peters GA, Cash RE, Goldberg SA, Gao J, Escudero T, Kolb LM, Camargo CA. Factors Associated With Potentially Unnecessary Transfers for Children With Asthma: A Retrospective Cohort Study. Pediatr Emerg Care 2024:00006565-990000000-00511. [PMID: 39173192 DOI: 10.1097/pec.0000000000003263] [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: 08/24/2024]
Abstract
OBJECTIVE Our objective was to identify the hospital- and community-related factors associated with the hospital-level rate of potentially unnecessary interfacility transfers (IFTs) for pediatric patients with asthma exacerbations. METHODS We analyzed California Emergency Department (ED) data from 2016 to 2019 to capture ED visits where a pediatric patient (age, 2-17 years) presented with an asthma exacerbation and was transferred to another ED or acute care hospital. The primary outcome was hospital-level rate of potentially unnecessary IFTs, defined as a visit where length of stay after transfer was <24 hours and no advanced services (eg, critical care) were used. Hospital- and community-related characteristics included urbanicity, teaching hospital status, availability of pediatric resources in the sending facility and patient's community, pediatric patient volume, and Social Vulnerability Index. We described and compared hospitals in the top quartile of potentially unnecessary IFT rate versus all others and used a multivariable modified Poisson model to identify factors associated with potentially unnecessary IFT. RESULTS A total of 325 sending hospitals were included, with a median 573 pediatric asthma visits (interquartile range, 183-1309) per hospital annually. Nearly half of the hospitals (145/325, 45%) sent a potentially unnecessary IFT. Most (90%) hospitals were urban, 9% were teaching hospitals, 5% had >500 beds, and 22% had a pediatric ED on-site. Factors associated with higher adjusted prevalence of potentially unnecessary IFT included availability of pediatric telehealth (prevalence ratio [PR], 1.5; 95% confidence interval [CI], 1.2-2.0), increased pediatric volume (eg, <1800 vs ≥10,000 visits: PR, 2.6; 95% CI, 1.4-4.7), and higher community Social Vulnerability Index (PR, 1.5; 95% CI, 1.1-1.9). CONCLUSIONS Several hospital- and community-related factors were associated with potentially unnecessary IFTs among pediatric patients presenting to the ED with asthma exacerbations. These findings provide insight into disparities in potentially unnecessary IFT across communities and can guide the development of future interventions.
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Affiliation(s)
| | | | | | - Jingya Gao
- Department of Emergency Medicine, Massachusetts General Hospital
| | | | - Lily M Kolb
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY and
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Seften LM, Scharnetzki E, Kirezi C, Craig A. Clinician Stakeholder Experience With Telemedicine Consults to Assess Neonatal Encephalopathy in a Rural State. Pediatr Neurol 2024; 160:1-7. [PMID: 39173305 DOI: 10.1016/j.pediatrneurol.2024.07.013] [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: 01/26/2024] [Revised: 07/20/2024] [Accepted: 07/23/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Serial neonatal encephalopathy (NE) examinations are difficult to perform in rural community hospitals as on-site experts are not readily available. We implemented a synchronous, acute care model of teleconsultation-the Maine Neonatal Encephalopathy Teleconsultation program (Maine NET)-to provide remote, joint assessment of NE by pediatric neurology and neonatology at nine community hospitals and one tertiary care center. We performed a qualitative study to interview clinicians about their experience of this program. METHODS From April 2018 to October 2022, we employed a semistructured interview format with 16 clinicians representing all participating hospitals. We utilized deductive analysis to assign a set of predefined codes to the transcribed interviews. RESULTS Thematic analysis supported the anticipated benefits of Maine NET, demonstrating that clinicians felt resource utilization, collaborative decision making, communication, and continuity of care were improved. Clinicians overwhelmingly supported the program: "This program has truly saved babies' lives and future function. I have not met any parents through this journey, who aren't incredibly grateful for the care that is provided" and emphasized the benefit of collaboration between all care team members. Teleconsultation was felt to be "more than adequate to [assess] NE." Connectivity issues were cited as a limitation. CONCLUSIONS Maine NET has positively impacted care delivery for newborns with clinical concerns for NE. Additionally, the program has improved resource allocation, collaborative decision making, communication, and equity of care. Addressing technological challenges will be vital to the success and sustainability of the planned Maine NET expansion.
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Affiliation(s)
- Leah Marie Seften
- Research Coordinator, The Barbara Bush Children's Hospital Scholarship Academy at Maine Medical Center, Portland, Maine
| | | | | | - Alexa Craig
- Associate Professor of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts; Division of Pediatric Neurology, Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
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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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Caffery LJ, Catapan SDC, Taylor ML, Kelly JT, Haydon HM, Smith AC, Snoswell CL. Telephone versus video consultations: A systematic review of comparative effectiveness studies and guidance for choosing the most appropriate modality. J Telemed Telecare 2024:1357633X241232464. [PMID: 38419502 DOI: 10.1177/1357633x241232464] [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: 03/02/2024]
Abstract
OBJECTIVE This systematic review compared clinical, service and cost effectiveness of telephone consultations (TC) to video consultations (VC). METHODS We searched Embase, CINAHL and MEDLINE for empirical studies that compared TC to VC using clinical, service or economic outcome measures. Clinician or patient preference and satisfaction studies were excluded. Findings were synthesised descriptively. RESULTS A total of 79 articles were included. The most effective modality was found to be VC in 40 studies (50%) and TC in 3 (4%). VC and TC were found to be equivalent in 28 of the included articles (35%). VC were superior or equivalent to TC for all clinical outcomes. When compared to TC, VC were likely to have better patient engagement and retention, to improve transfer decisions, and reduce downstream sub-acute care utilisation. The impact of telehealth modality on consultation time, completion rates, failure-to-attend rates and acute care utilisation was mixed. VC were consistently found to be more cost effective despite having a higher incremental cost than TC. CONCLUSIONS Our systematic review demonstrates equal or better, but not inferior clinical and cost outcomes for consultations delivered by VC when compared to TC. VC appear to be more clinically effective when visual information is required, when verbal communication with the patient is impaired and when patient engagement and retention is linked to clinical outcomes. We have provided conditions where VC should be used in preference to TC. These can be used by clinicians to guide the choice of telehealth modality. Cost effectiveness is also important to consider when choosing modality.
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Affiliation(s)
- Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Soraia De Camargo Catapan
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
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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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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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Waasdorp Hurtado C, Neigut D, Hoffenberg EJ, Geyer B, Marable J, Combest N, Yousuf S, Olson CA. Telehealth Coverage for a Pediatric Gastroenterology Consult Service at a Regional Hospital: An Accepted, Useful, and Sustainable Model of Care. J Pediatr 2023; 262:113341. [PMID: 36736891 PMCID: PMC10905322 DOI: 10.1016/j.jpeds.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/05/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate a novel telehealth inpatient pediatric gastroenterology (GI) consult service at a regional children's hospital in regard to acceptance, utility, quality, sustainability, and provider resiliency. STUDY DESIGN Patients requiring GI care at a regional children's hospital between July 2020 and June 2021 were treated by an in-person or telehealth physician with physician assistant support, randomly assigned based on a weekly preset staffing schedule. A retrospective, multidomain program evaluation was performed based on the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) and STEM (SPROUT Telehealth Evaluation and Management) frameworks, using statistical analysis to compare the patient cohorts and anonymous surveys to assess provider perceptions. RESULTS In total, 1051 patient-days of GI care were provided for 348 patients, 17% by telehealth and 83% in-person. There were no significant differences in diagnosis, transfer, or readmission rates between the cohorts. No transfers occurred for reasons other than need to access specialized services not available at the regional hospital. Daily consult workload was slightly greater for telehealth physicians. Primary and consult team providers accepted the practice. The model continued beyond the first year. In total, 75% of local GI physicians reported greater Brief Resilience Scores in the context of shifting 20% of their inpatient call weeks to another campus's physicians. CONCLUSION Episodic pediatric GI consult service coverage via telehealth at a regional hospital was well accepted, useful, and sustainable, with improved physician resilience and no adverse outcomes seen. Telehealth holds promise for leveraging pediatric subspecialty physicians across hospitals, allowing complex patients to be admitted closer to home while reducing inpatient coverage requirements for smaller physician groups.
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Affiliation(s)
- Christine Waasdorp Hurtado
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Colorado Springs, CO; Children's Hospital Colorado-Colorado Springs Campus, Colorado Springs, CO.
| | - Deborah Neigut
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Colorado Springs, CO; Children's Hospital Colorado-Anschutz Medical Campus, Aurora, CO
| | - Edward J Hoffenberg
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Colorado Springs, CO; Children's Hospital Colorado-Anschutz Medical Campus, Aurora, CO
| | - Brooke Geyer
- Children's Hospital Colorado-Colorado Springs Campus, Colorado Springs, CO; Section of Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine, Colorado Springs, CO
| | - Jennifer Marable
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Colorado Springs, CO; Children's Hospital Colorado-Colorado Springs Campus, Colorado Springs, CO
| | - Nichole Combest
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Colorado Springs, CO; Children's Hospital Colorado-Colorado Springs Campus, Colorado Springs, CO
| | - Sana Yousuf
- Children's Hospital Colorado-Anschutz Medical Campus, Aurora, CO
| | - Christina A Olson
- Children's Hospital Colorado-Anschutz Medical Campus, Aurora, CO; Section of Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine, Colorado Springs, CO
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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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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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Marcin JP, Sauers-Ford HS, Mouzoon JL, Haynes SC, Dayal P, Sigal I, Tancredi D, Lieng MK, Kuppermann N. Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers: A Cluster-Randomized Crossover Trial. JAMA Netw Open 2023; 6:e2255770. [PMID: 36780158 PMCID: PMC9926323 DOI: 10.1001/jamanetworkopen.2022.55770] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
IMPORTANCE Pediatric referral centers are increasingly using telemedicine to provide consultations to help care for acutely ill children presenting to rural and community emergency departments (EDs). These pediatric telemedicine consultations may help improve physician decision-making and may reduce the frequency of overtriage and interfacility transfers. OBJECTIVE To examine the use of pediatric critical care telemedicine vs telephone consultations associated with risk-adjusted transfer rates of acutely ill children from community and rural EDs. DESIGN, SETTING, AND PARTICIPANTS A cluster-randomized crossover trial was conducted between November 18, 2015, and March 26, 2018. Analyses were conducted from January 19, 2018, to July 23, 2022, 2022. Participants included acutely ill children aged 14 years and younger presenting to a participating ED in 15 rural and community EDs in northern California. INTERVENTIONS Participating EDs were randomized to use telemedicine or telephone for consultations with pediatric critical care physicians according to 1 of 4 unbalanced (3 telemedicine:1 telephone) crossover treatment assignment sequences. MAIN OUTCOMES AND MEASURES Intention-to-treat, treatment-received, and per-protocol analyses were performed to determine the risk of transfer using mixed effects Poisson regression analyses with random intercepts for presenting EDs to account for hospital-level clustering. RESULTS A total of 696 children (392 boys [56.3%]; mean [SD] age, 4.2 [4.6] years) were enrolled. Of the 537 children (77.2%) assigned to telemedicine, 251 (46.7%) received the intervention. In the intention-to-treat analysis, patients assigned to the telemedicine arm were less likely to be transferred compared with patients assigned to the telephone arm after adjusting for patient age, severity of illness, and hospital study period (risk rate [RR], 0.93; 95% CI, 0.88-0.99). The adjusted risk of transfer was significantly lower in the telemedicine arm compared with the telephone arm in both the treatment-received analysis (RR, 0.81; 95% CI, 0.71-0.94) and the per-protocol analysis (RR, 0.79; 95% CI, 0.68-0.92). CONCLUSIONS AND RELEVANCE In this randomized trial, the use of telemedicine to conduct consultations for acutely ill children in rural and community EDs resulted in less frequent overall interfacility transfers than consultations done by telephone. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02877810.
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Affiliation(s)
- James P. Marcin
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Hadley S. Sauers-Ford
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Jamie L. Mouzoon
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Sarah C. Haynes
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Parul Dayal
- Genentech Inc, South San Francisco, California
| | - Ilana Sigal
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Daniel Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Monica K. Lieng
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Nathan Kuppermann
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
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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: 2] [Impact Index Per Article: 2.0] [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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12
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Rosenthal JL, Ketchersid A, Horath E, Sanders A, Harper TA, Hoyt-Austin AE, Haynes SC. Using human-centered design to develop a nurse-to-family telehealth intervention for pediatric transfers. Digit Health 2023; 9:20552076231219123. [PMID: 38107976 PMCID: PMC10725135 DOI: 10.1177/20552076231219123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Objective To develop a nurse-to-family telehealth intervention for pediatric inter-facility transfers using the human-centered design approach. Methods We conducted the inspiration and ideation phases of a human-centered design process from July 2022 to December 2022. For the inspiration phase, we conducted a qualitative cross-sectional case study design over 3 months. We used thematic analysis with the framework approach of parent and provider interviews. Five team members individually coded transcripts and then met to discuss memos, update a construct summary sheet, and identify emerging themes. The team adapted themes into "How Might We" statements. For the ideation phase, multidisciplinary stakeholders brainstormed solutions to the "How Might We" statements in a design workshop. Workshop findings informed the design of a nurse-to-family telehealth intervention, which was iteratively revised over 2 months based on stakeholder feedback sessions. Results We conducted interviews with nine parents, 11 nurses, and 13 physicians. Four themes emerged supporting the promise of a nurse-to-family telehealth intervention, the need to effectively communicate the intervention purpose, the value of a user-friendly workflow, and the essentiality of ensuring that diverse populations equitably benefit from the intervention. "How Might We" statements were discussed among 22 total workshop participants. Iterative adaptations were made to the intervention until feedback from workshop participants and 67 other stakeholders supported no further improvements were needed. Conclusion Human-centered design phases facilitated stakeholder engagement in developing a nurse-to-family telehealth intervention. This intervention will be tested in an implementation phase as a feasibility and pilot trial.
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Affiliation(s)
- Jennifer L Rosenthal
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
- Center for Health and Technology, University of California Davis, Sacramento, CA, USA
| | - Audriana Ketchersid
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - Elva Horath
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - April Sanders
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - Thomas A Harper
- Center for Health and Technology, University of California Davis, Sacramento, CA, USA
| | | | - Sarah C Haynes
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
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13
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Totten AM, Womack DM, Griffin JC, McDonagh MS, Davis-O'Reilly C, Blazina I, Grusing S, Elder N. Telehealth-guided provider-to-provider communication to improve rural health: A systematic review. J Telemed Telecare 2022:1357633X221139892. [PMID: 36567431 DOI: 10.1177/1357633x221139892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Telehealth may address healthcare disparities for rural populations. This systematic review assesses the use, effectiveness, and implementation of telehealth-supported provider-to-provider collaboration to improve rural healthcare. METHODS We searched Ovid MEDLINE®, CINAHL®, EMBASE, and Cochrane CENTRAL from 1 January 2010 to 12 October 2021 for trials and observational studies of rural provider-to-provider telehealth. Abstracts and full text were dual-reviewed. We assessed the risk of bias for individual studies and strength of evidence for studies with similar outcomes. RESULTS Seven studies of rural uptake of provider-to-provider telehealth documented increases over time but variability across geographic regions. In 97 effectiveness studies, outcomes were similar with rural provider-to-provider telehealth versus without for inpatient consultations, neonatal care, outpatient depression and diabetes, and emergency care. Better or similar results were reported for changes in rural clinician behavior, knowledge, confidence, and self-efficacy. Evidence was insufficient for other clinical uses and outcomes. Sixty-seven (67) evaluation and qualitative studies identified barriers and facilitators to implementing rural provider-to-provider telehealth. Success was linked to well-functioning technology, sufficient resources, and adequate payment. Barriers included lack of understanding of rural context and resources. Methodologic weaknesses of studies included less rigorous study designs and small samples. DISCUSSION Rural provider-to-provider telehealth produces similar or better results versus care without telehealth. Barriers to rural provider-to-provider telehealth implementation are common to practice change but include some specific to rural adaptation and adoption. Evidence gaps are partially due to studies that do not address differences in the groups compared or do not include sufficient sample sizes.
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Affiliation(s)
| | - Dana M Womack
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | | - Ian Blazina
- Oregon Health & Science University, Portland, OR, USA
| | - Sara Grusing
- Oregon Health & Science University, Portland, OR, USA
| | - Nancy Elder
- Oregon Health & Science University, Portland, OR, USA
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14
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Chuo J, Makkar A, Machut K, Zenge J, Jagarapu J, Azzuqa A, Savani RC. Telemedicine across the continuum of neonatal-perinatal care. Semin Fetal Neonatal Med 2022; 27:101398. [PMID: 36333212 PMCID: PMC9623499 DOI: 10.1016/j.siny.2022.101398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- John Chuo
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Abhishek Makkar
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center; Oklahoma City, Oklahoma, USA
| | - Kerri Machut
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jeanne Zenge
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital of Colorado, Aurora, CO, USA
| | - Jawahar Jagarapu
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abeer Azzuqa
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Rashmin C. Savani
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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15
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Abstract
INTRODUCTION Telemedicine gained an increasing use throughout the last years. Lifestyle tools like the Apple watch seem to have an increasing spread even in remote areas and underdeveloped regions. The increasing availability of these tools offers the chance to use the health care functions of these devices to improve provision of professional medical care. First data on the use of the Apple Watch as a remote monitoring device in children have been reported, showing good acceptability and usability of the Apple Watch for symptom monitoring in children. This study aimed to evaluate the accuracy of the Apple Watch iECG in comparison to a standard 12-lead ECG in pre-term babies. METHODS In this prospective, single-arm study, consecutive preterm neonates hospitalised in Leipzig University Hospital neonatal ICU were eligible. A 12-lead ECG and an iECG using Apple Watch 4 were performed. iECG and 12-lead ECG measurements were performed by a paediatric cardiologist. Cardiac rhythm was classified and amplitudes and timing intervals were analysed for comparability. RESULTS Fifty preterm neonates, gestational week (23-36 weeks), and body weight (0.65-3.09 kg) were enrolled. Overall good quality and excellent correlation of the Apple Watch generated iECG in comparison to the standard 12-lead ECG could be demonstrated (p < 0.001). When interpreted by a paediatric cardiologist, a correct rhythm classification could be done in 100% of cases. CONCLUSION The Apple Watch iECG seems to be a valuable tool to record an ECG comparable to lead I of the standard 12-lead ECG even in pre-term neonates. With a widespread availability and excellent connectivity, the Apple Watch iECG function may provide practitioners with a tool to send an iECG for interpretation to a paediatric cardiac specialist.
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16
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Yoo BK, Yang NH, Hoffman K, Sasaki T, Haynes SC, Mouzoon J, Marcin JP. Economic Evaluation of Telemedicine Consultations to Reduce Unnecessary Neonatal Care Transfers. J Pediatr 2022; 244:58-63.e1. [PMID: 35074308 DOI: 10.1016/j.jpeds.2021.11.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/05/2021] [Accepted: 11/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To perform an economic evaluation to estimate the return on investment (ROI) of making available telemedicine consultations from a healthcare payer perspective, and to estimate the economic impacts of telemedicine under a hypothetical scenario in which all rural hospitals providing level I neonatal care in California had access to telemedicine consultations from neonatologists at level III and level IV neonatal intensive care units (NICUs). STUDY DESIGN We developed standard decision models with assumptions derived from primary data and the literature. Telemedicine costs included equipment installation and operation costs. Probabilistic analysis with Monte Carlo simulation was performed to address model uncertainties and to estimate 95% probabilistic confidence intervals (PCIs). All costs were adjusted to 2017 US dollars using the Consumer Price Index. RESULTS Our probabilistic analysis estimated the ROI to have a mean value of 2.23 (95% PCI, -0.7 to 6.0). That is, a $1 investment in this telemedicine model would yield a net medical expenditure saving of $1.23. "Cost saving" was observed for 75% of the hypothetical 1000 Monte Carlo simulations. For the state of California, the estimated mean annual net savings was $661 000. CONCLUSIONS Providing telemedicine and making available consultations to rural hospitals providing level I neonatal care are likely to reduce medical expenditures by reducing potentially avoidable transfers of newborns to level III and IV NICUs, offsetting all telemedicine-related costs.
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Affiliation(s)
- Byung-Kwang Yoo
- Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA
| | - Nikki H Yang
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA
| | - Kristin Hoffman
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA
| | | | - Sarah C Haynes
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA
| | - Jamie Mouzoon
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA
| | - James P Marcin
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA.
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17
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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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18
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Kothari SY, Haynes SC, Sigal I, Magana JN, Ruttan T, Kuppermann N, Horeczko T, Ludwig L, Karsteadt L, Chapman W, Pinette V, Marcin JP. Resources for Improving Pediatric Readiness and Quality of Care in Rural Communities and Emergency Departments. Pediatr Emerg Care 2022; 38:e1069-e1074. [PMID: 35226633 DOI: 10.1097/pec.0000000000002658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To share the process and products of an 8-year, federally funded grant from the Health Resources and Services Administration Emergency Medical Services for Children program to increase pediatric emergency readiness and quality of care provided in rural communities located within 2 underserved local emergency medical services agencies (LEMSAs) in Northern California. METHODS In 2 multicounty LEMSAs with 24 receiving hospital emergency departments, we conducted focus groups and interviews with patients and parents, first responders, receiving hospital personnel, and other community stakeholders. From this, we (a regional, urban children's hospital) provided a variety of resources for improving the regionalization and quality of pediatric emergency care provided by prehospital providers and healthcare staff at receiving hospitals in these rural LEMSAs. RESULTS From this project, we provided resources that included regularly scheduled pediatric-specific training and education programs, pediatric-specific quality improvement initiatives, expansion of telemedicine services, and cultural competency training. We also enhanced community engagement and investment in pediatric readiness. CONCLUSIONS The resources we provided from our regional, urban children's hospital to 2 rural LEMSAs facilitated improvements in a regionalized system of care for critically ill and injured children. Our shared resources framework can be adapted by other regional children's hospitals to increase readiness and quality of pediatric emergency care in rural and underserved communities and LEMSAs.
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Affiliation(s)
| | | | | | - Julia N Magana
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX
| | | | - Timothy Horeczko
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Lorah Ludwig
- Emergency Medical Services for Children, Division of Child, Adolescent, and Family Health, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD
| | | | | | - Vickie Pinette
- Sierra-Sacramento Valley Emergency Medical Services, Rocklin, CA
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19
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Oelmeier K, Schmitz R, Möllers M, Braun J, Deharde D, Sourouni M, Köster HA, Apsite G, Eveslage M, Fischhuber K, Storck M, Emming F, Wohlmann J, Juhra C. Satisfaction with and Feasibility of Prenatal Counseling via Telemedicine: A Prospective Cohort Study. Telemed J E Health 2021; 28:1193-1198. [PMID: 34861131 DOI: 10.1089/tmj.2021.0309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Telemedicine has become increasingly important over the past decade. With the pressure of the COVID-19 pandemic, demands for remote health care solutions have seen an unprecedented rise. However, many questions regarding the feasibility and benefits of telemedicine remain. The aim of our study was to evaluate both the technical feasibility and patient satisfaction with video consultations in a tertiary center for obstetric care. Materials and Methods: This prospective single-center trial was part of the larger open Video Service project on telemedicine at the Department of Gynecology and Obstetrics at the University of Münster. Patients requiring prenatal or prepregnancy counseling were included. A questionnaire was designed for the evaluation of patient satisfaction and filled in by both patient and health care provider at the end of the video consultation. Results: Of 80 eligible cases, 75 video consultations were carried out and data from the questionnaire were collected. Overall patient satisfaction was high (95%, 71/75) although technical problems occurred in 37% (29/75) of the appointments. Health care providers' satisfaction was equally high and in 88% (66/75) of cases, remote consultations avoided an in-house visit without effect on health care quality. Conclusions: Remote consultations are feasible and yield high satisfaction rates even in a medical field as sensitive as perinatal medicine. Further research is necessary to determine the cost-effectiveness and effects on perinatal outcome. Health care systems should be offered clear guidance on medicolegal issues and funding of remote consultations to integrate telemedicine into routine health care.
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Affiliation(s)
- Kathrin Oelmeier
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Janina Braun
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Daniela Deharde
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Marina Sourouni
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Helen Ann Köster
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Gunita Apsite
- Centre for Clinical Trials Münster, University of Münster, Münster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Karen Fischhuber
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Franziska Emming
- Office for eHealth, University Hospital Münster, Münster, Germany
| | - Jan Wohlmann
- Office for eHealth, University Hospital Münster, Münster, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Münster, Münster, Germany
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20
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Mavis SC, Kreofsky BL, Ouk MY, Carey WA, Fang JL. Training fellows in neonatal tele-resuscitation using a simulation-based mastery learning model. Resusc Plus 2021; 8:100172. [PMID: 34693381 PMCID: PMC8517198 DOI: 10.1016/j.resplu.2021.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Neonatal tele-resuscitation uses real-time, audio-video telemedicine to connect neonatologists with community hospital care teams during advanced neonatal resuscitations. While telemedicine continues to expand, best practices for training fellows in tele-resuscitation are not known. OBJECTIVE We aimed to develop a neonatal tele-resuscitation curriculum using a simulation-based mastery learning model that provides neonatal-perinatal medicine (NPM) fellows with the knowledge, skills, and behaviors needed to lead tele-resuscitations. METHODS Using technology-enhanced simulation education and a mastery learning model, we developed a longitudinal pilot tele-resuscitation curriculum. From 07/2018 to 03/2021, NPM fellows participated in the curriculum, which included individualized telemedicine learning, observing and leading simulated tele-resuscitations, and finally, performing clinical (non-simulated) tele-resuscitations. A performance assessment tool was developed to assess competency through eight questions mapped to the Accreditation Council for Graduate Medical Education (ACGME) core competencies, with responses on a 1 to 5 scale (1 = critical deficiencies; 5 = competence of an expert). RESULTS Four NPM fellows participated in the curriculum, progressing through the curriculum at an individualized pace. Median scores on the three learning modules were 96-100%. Fellows participated in variable number of simulated tele-resuscitations based on when mastery was achieved (2-3 supervised simulations per fellow, 1-4 unsupervised simulations per fellow). In total, eighteen simulated tele-resuscitations (eight unsupervised, 10 supervised) and one clinical tele-resuscitation were conducted. Twenty-five performance assessments were completed. Assessment scores across the ACGME competencies were consistently high, with mean scores ranging from 4.2-4.6, with 4 equating to 'ready for unsupervised practice' and 5 equating to 'competence of an expert'. CONCLUSIONS As telemedicine use continues to expand, curricula that improve learners' comfort with and proficiency in tele-resuscitation are essential. A simulation-based mastery learning model may be one approach that affords learners gradual exposure to and mastery of complex tele-resuscitation skills and behaviors.
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Affiliation(s)
- Stephanie C. Mavis
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Beth L. Kreofsky
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Melody Y. Ouk
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - William A. Carey
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L. Fang
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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21
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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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22
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Jagarapu J, Savani RC. Development and implementation of a teleneonatology program: Opportunities and challenges. Semin Perinatol 2021; 45:151428. [PMID: 34176650 DOI: 10.1016/j.semperi.2021.151428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Teleneonatology, encompassing all telemedicine applications in neonatal medicine, is evolving with innovative applications for use in all aspects of neonatal care. In this chapter, we discuss the key components of and a framework for the development, implementation and evaluation of a program based on existing literature and our own program. We also review some important barriers to implementation and potential solutions. We hope that this review will serve as a guide for those seeking to develop and implement other new teleneonatology programs.
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Affiliation(s)
- Jawahar Jagarapu
- The Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Rashmin C Savani
- The Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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23
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Abstract
Over a century of innovations in technology and medical care have led to the current day capabilities in telemedicine. In this chapter, we discuss the evolution of telemedicine over the last century and highlight various applications in neonatal care. We hope this chapter demonstrates the exponential adoption of telemedicine, particularly in neonatology, and the breadth and depth of the technology being used.
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24
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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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25
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McDaniel CE, Leyenaar J, Sullivan E, Desai S, Kessler L. Pediatric Conditions Requiring Minimal Intervention or Observation After Interfacility Transfer. J Hosp Med 2021; 16:412-415. [PMID: 34197305 DOI: 10.12788/jhm.3656] [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] [Received: 02/25/2021] [Accepted: 05/18/2021] [Indexed: 11/20/2022]
Abstract
Increasing regionalization of pediatric care has led to interfacility transfer of children with general pediatric conditions at rates similar to those of high-risk adults, which may delay appropriate treatment. We sought to identify common medical diagnoses that did not require significant advanced intervention and that had high rates of discharge within 1 day of interfacility transfer. Using the Pediatric Health Information System (PHIS) database, we identified all transfers into PHIS-participating children's hospitals in 2019. We excluded encounters for mental health, labor/maternity, primary newborn diagnoses, and direct admissions to an intensive care unit. Eligible encounters were categorized by duration of hospitalization and basic vs advanced intervention after transfer. Of 286,905 transfers, 197,386 (68.6%) met inclusion criteria. Cough, febrile seizures, croup, and allergic reactions required advanced interventions <10% of the time, and patients with these diagnoses were most commonly discharged within 1 day after transfer. These conditions are potential targets for building pediatric capacity in non-pediatric hospitals.
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Affiliation(s)
- Corrie E McDaniel
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - JoAnna Leyenaar
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Erin Sullivan
- Seattle Children's Research Institute, Seattle, Washington
| | - Sanyukta Desai
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children's Research Institute, Seattle, Washington
| | - Larry Kessler
- Seattle Children's Research Institute, Seattle, Washington
- Department of Health Services, University of Washington, Seattle, Washington
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26
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Oelmeier K, Schmitz R, Braun J, Möllers M, Klockenbusch W, Juhra C. Telemedizin in der Pränataldiagnostik in Zeiten der COVID-19-Pandemie: erste Erkenntnisse aus dem oVID-Projekt. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1389-9576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Kathrin Oelmeier
- Bereich Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe am Universitätsklinikum Münster, Münster
| | - Ralf Schmitz
- Bereich Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe am Universitätsklinikum Münster, Münster
| | - Janina Braun
- Bereich Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe am Universitätsklinikum Münster, Münster
| | - Mareike Möllers
- Bereich Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe am Universitätsklinikum Münster, Münster
| | - Walter Klockenbusch
- Bereich Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe am Universitätsklinikum Münster, Münster
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27
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Haynes SC, Hoffman KR, Patel S, Smith S, Romano PS, Marcin JP. The Use of Telemedicine for Stabilization of Neonates Transferred from Rural Community Hospitals. Telemed J E Health 2021; 27:1393-1398. [PMID: 33691080 DOI: 10.1089/tmj.2020.0503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: For newborns requiring transfer to a higher level of care, stabilization before the arrival of the transport team is essential. Telemedicine consultations with a neonatologist may improve local providers' ability to stabilize a newborn during this critical interval. The purpose of this study was to describe the use of telemedicine for stabilizing newborns who were transferred from one of six rural hospitals to a regional neonatal intensive care unit in northern California and to examine the association between telemedicine use and time needed to stabilize the newborn. Materials and Methods: We collected data on all newborns who were transferred after either a telemedicine or telephone consultation with a neonatologist between April 2014 and June 2018. We used multiple regression to examine the association between the use of telemedicine and stabilization time, adjusting for gestational age, 5-min Apgar score, birth weight, site, and primary reason for consultation. Results: In total, 162 infants (77.5%) received a telephone consultation and 47 (22.5%) received a telemedicine consultation. Neonates who received telemedicine had a significantly greater severity of illness, as measured by mean 5-min Apgar score (6.9 vs. 7.8, p = 0.008) and Transport Risk Index of Physiologic Stability version II (TRIPS-II) score (14.4 vs. 6.0, p < 0.001). There was no significant difference in stabilization time for telemedicine consultations compared with telephone consultations in the adjusted analysis (adjusted mean difference: -1.80, 95% confidence interval: -16.0 to 12.4, p = 0.802). Conclusions: Although we found no difference in stabilization times between modes of consultation, telemedicine may be helpful for stabilizing infants with a higher severity of illness, particularly those in respiratory distress. Future studies should examine the impact of telemedicine on specific interventions.
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Affiliation(s)
- Sarah C Haynes
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Kristin R Hoffman
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Sonal Patel
- Department of Pediatrics, St. Francis Health System, Tulsa, Oklahoma, USA
| | - Stanley Smith
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Patrick S Romano
- Division of General Medicine, Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | - James P Marcin
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
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28
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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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29
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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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30
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The fourth industrial revolution and the coronavirus: a new era catalyzed by a virus ☆. RESEARCH IN GLOBALIZATION 2020; 2. [PMCID: PMC7564759 DOI: 10.1016/j.resglo.2020.100024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The global pandemic caused by the new coronavirus, COVID 19, has disrupted the lives of most people on the planet. The magnitude of such disruption can only be compared to those caused by World War II. Experts suggest that in order to better evaluate this situation, it should be divided into two waves. The first wave being associated with health issues and the second one with economic issues. This article suggests that this global pandemic is fostering yet a third wave, which in the long run can be much more impactful in our lives than the first two. This third wave consists on accelerating the implantation process of the fourth industrial revolution. This article is divided into sections with the physical, digital and biological spheres of the fourth industrial revolution, as well as the dimensions of sustainability and other important considerations, in order to better demonstrate the emergence of a new era catalyzed by a virus.
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31
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Ramgopal S. Interfacility transports by emergency medical services in the United States: Estimates from the National Hospital Ambulatory Medical Care Survey. Am J Emerg Med 2020; 38:2244.e3-2244.e6. [DOI: 10.1016/j.ajem.2020.05.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/30/2020] [Accepted: 05/19/2020] [Indexed: 11/29/2022] Open
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