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Wang J, He G. Meta-Analysis of eVisit Technology on Psychological Anxiety and Factors Influencing the Parents of NICU Newborns. Adv Neonatal Care 2024:00149525-990000000-00151. [PMID: 39326007 DOI: 10.1097/anc.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
BACKGROUND Due to the geographical distance, work obligations, and parenting responsibilities, it is often difficult for parents to visit the neonatal intensive care unit (NICU). Limited parent presence might also constrain updates about infant status thus increasing anxiety, which potentially leads to a stronger necessity for visitation. PURPOSE Examine the evidence for use of electronic visit (eVisit) technology for parents of newborns in NICU, for example, do eVisits decrease anxiety and are there other factors that demonstrate effectiveness. DATA SOURCES Seven databases were used to search for evidence from 1 January 2000 to 13 November 2023. STUDY SELECTION Studies were included with terms related to eHealth, NICU, infant, parent and 41 eligible studies were assessed. DATA EXTRACTION Data were extracted by 2 reviewers with a systematic-staged review approach. RESULTS Eight studies with a total of 1450 cases were included. Results of meta-analysis showed that eVisit technology improved anxiety compared with conventional visitation (MD = - 5.04, 95% CI [-5.92, - 4.17], P < .01) and hospitalization satisfaction (RR = 1.09, 95% CI [1.05, 1.13], P < .01), but the effect was not significant with regard to reduction in infant length of stay (MD = - 1.07, 95% CI [-5.39, 3.25], P = .63). IMPLICATIONS FOR PRACTICE AND RESEARCH A large sample, high-quality, multi-centered randomized controlled study needs to be conducted to validate the effect of eVisit technology on the psychological state of parents, implications for nursing practice as well as potential newborn affects to improve future ease of use. VIDEO ABSTRACT Available for more insights from the authors. This video shows the concept, current status, significance, and implications for practice and research of eVisit technology.
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Affiliation(s)
- Jiayi Wang
- Author Affiliation: School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Alnasser Y, Proaño A, Loock C, Chuo J, Gilman RH. Telemedicine and Pediatric Care in Rural and Remote Areas of Middle-and-Low-Income Countries: Narrative Review. J Epidemiol Glob Health 2024; 14:779-786. [PMID: 38478166 PMCID: PMC11442723 DOI: 10.1007/s44197-024-00214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/24/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVES Caring for children in low- and middle-income countries (LMIC) can be challenging. This review article aims to explore role of telemedicine in supporting pediatric care in LMIC. METHODOLOGY A narrative review of existing English and Spanish literature was conducted to assess role of telemedicine to support pediatric care in LMIC. RESULTS Beside medical education and direct pediatric care, telemedicine can provide sub-specialties consultations without extra burden on families. Additionally, telemedicine can help in lowering under-5 mortality by supporting neonatal care, infectious illnesses, and non-communicable diseases (NCDs). Telemedicine can be a gate for universal coverage for all children at a lower cost. For over a decade, it has been implemented successfully and sustained in a few LMIC. However, challenges in implementing telemedicine are enormous. Still, opportunities arise by using simpler technology, low-width band internet, smartphones, instant messaging applications and solar energy. COVID-19 pandemic facilitated acceptance and applicability of telemedicine worldwide including LMIC. Nevertheless, governments must regulate telemedicine by issuing policies and ensuring employment of local experts when possible to meet local resources and cultural competency. CONCLUSION Telemedicine has proven successful in improving pediatrics care. Many LMIC should take advantage of this innovation to promote equity and access to high quality pediatric care.
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Affiliation(s)
- Yossef Alnasser
- Milken Institute of Public Health, George Washington University, Washington, DC, USA.
- Pediatric Department, King Saud University, Riyadh, Saudi Arabia.
- Pediatric Department, BronxCare Health System, Bronx, NY, USA.
| | - Alvaro Proaño
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christine Loock
- British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John Chuo
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert H Gilman
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Agarwal N, Anand R, Jindal A, Varghese AR, Gajjala C, Ryavanki SP, Singh G. A Hybrid Form of Telemedicine and Quality Improvement: A Unique Way to Extend Intensive Care Services to Neonates. Indian J Pediatr 2024:10.1007/s12098-024-05200-3. [PMID: 39007957 DOI: 10.1007/s12098-024-05200-3] [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: 02/02/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES To evaluate the impact of hybrid support (tele-mentoring and conventional support) on adverse outcome among neonates admitted to 10 special newborn care units (SNCUs) in Chhattisgarh. METHODS This before-and-after study was conducted at 10 SNCUs in Chhattisgarh in 2022. Conventional support was given earlier and later, that was supplemented with tele-rounds which were carried out using Skype technology. The principal investigator (PI) visited each unit for one day per month to kickstart quality improvement (QI) projects and provide guidance. Patient outcome data were collected on clinical sepsis proportion, IV fluid usage, antibiotic usage, length of stay, referral and mortality. RESULTS A total of 2807 babies across 10 units were assessed. This was retrospectively correlated with 5169 babies in these units in the year before the intervention was started. The percentage of clinical neonatal sepsis cases decreased from 53.4% to 29.4% (P < 0.05). IV fluid usage dropped from 40% to 22.2% (P < 0.05). The initiation and continuation of kangaroo mother care (KMC) increased from 55.5% to 93.8% (P < 0.05). The average length of stay decreased from 5.5 ± 0.97 d to 4 ± 0.2 d (P < 0.05). Oxygen utilization decreased from 39.3% to 33.6% (P < 0.05). The proportion of antibiotic usage decreased from 50.2% to 39.7% (P < 0.05). The mortality rate decreased from 8.18% to 6.99% (P < 0.05). Referral rate decreased from 13.12% to 11.93% (P < 0.05). CONCLUSIONS The implementation of a QI package through hybrid support, which includes tele-mentoring, supportive supervision visits, and local QI project advocacy, proves to be an effective approach in enhancing newborn intensive care.
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Affiliation(s)
- Nikita Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 492099, India
| | - Rohit Anand
- Department of Neonatology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Atul Jindal
- Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 492099, India.
| | - Anjali Rachel Varghese
- Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 492099, India
| | - Chandana Gajjala
- Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 492099, India
| | - Sridhar Prahlad Ryavanki
- Health Specialist, UNICEF Field Office for Andhra Pradesh, Karnataka and Telangana, UNICEF, Hyderabad, India
| | - Gajendra Singh
- Health Specialist, UNICEF Raipur Office, UNICEF, Raipur, India
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Ranu J, Hoffman KR, Sauers-Ford HS, Williams J, Rosenthal JL. A Qualitative Intervention Evaluation of Neonatal Virtual Family-Centered Rounds. Hosp Pediatr 2024; 14:463-473. [PMID: 38774983 PMCID: PMC11137623 DOI: 10.1542/hpeds.2023-007554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/06/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To conduct an implementation evaluation of the virtual family-centered rounds (FCR) intervention by exploring the perceptions and experiences of parents and care team providers. METHODS We conducted a qualitative descriptive study using a thematic analysis of unobtrusive observations of rounding encounters and semi-structured interviews with the parents of discharged infants and members of the neonatal care team. Eligible participants had used virtual FCR at least once. Five research team members independently performed focused coding and memo writing of transcripts and observation fieldnotes. The team met weekly to compare and refine codes, update the interview guide, develop tentative categories, and discuss the theoretical direction. RESULTS We conducted 406 minutes of unobtrusive observations and 21 interviews with parents, physicians, neonatal nurse practitioners, bedside nurses, dieticians, and pharmacists. Three themes and 13 subthemes emerged from the analysis: (1) virtual FCR improved perceived care delivery and clinical outcomes through increased opportunities for parent engagement, (2) the acceptance of virtual FCR by providers grew over time despite the persistent presence of technical challenges, and (3) the implementation of virtual FCR should be standardized and delivered by the care team to enhance usability, effectiveness, and sustainability. CONCLUSIONS Virtual FCR is perceived by NICU parents and care team providers to be a valuable intervention that can enhance family centered care. The identified virtual FCR implementation strategies should be tested in further studies.
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Affiliation(s)
- Jaskiran Ranu
- Mercy San Juan Medical Center, Carmichael, California
| | - Kristin R. Hoffman
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Hadley S. Sauers-Ford
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jacob Williams
- Graduate School of Biomedical Sciences & Professional Studies, Drexel University, Philadelphia, Pennsylvania
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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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Hallford HG, Szyld E, McCoy M, Makkar A. A 360 Evaluation of Neonatal Care Quality at a Level II Neonatal Intensive Care Unit when Delivered Using a Hybrid Telemedicine Service. Am J Perinatol 2024; 41:e711-e718. [PMID: 36037855 DOI: 10.1055/a-1932-9921] [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: 11/01/2022]
Abstract
OBJECTIVE In 2013, the Section of Neonatal and Perinatal Medicine at the University of Oklahoma's Children's Hospital began providing advanced care to a regional level II neonatal intensive care unit (NICU), using a hybrid telemedicine program. This project compares health care providers' and parents' assessments of health care quality using this program. STUDY DESIGN This is a prospective, anonymous, nonrandomized survey of health care providers and parents of neonates using our hybrid telemedicine services. Physicians, neonatal nurse practitioners (NNPs), nurses, and parents completed pencil-and-paper surveys based on their participatory roles. Institutional Review Board approval was obtained at OU Medical Center and Comanche County Memorial Hospital. Surveys consisted of 5-point Likert's scale questions. Descriptive statistics compared the level of agreement with each question across participant groups. A service quality (SQ) composite score was created by summing responses from six SQ questions. Between-group analysis was done on the SQ score using the Mann-Whitney U-test. RESULTS Nine physicians, 10 NNPs, 12 nurses, and 40 parents completed the survey. Providers agreed (90%) that telemedicine can effectively deliver advanced neonatal care; the care patients receive is comparable to direct patient care (87%); telemedicine enhanced overall patient care quality (90%); providers can effectively interact with each other and families using telemedicine (90.3%), and overall telemedicine experience was good (90%). In total, 61% of providers reported telemedicine improves physician-patient interaction. Parents of newborns agreed that they were well informed about telemedicine use for their child's care (88%), were able to communicate routinely with neonatologists (85%), and were comfortable with their child's physical examinations (93%). Provider's versus family's (SQ) score was not significantly different. CONCLUSION All survey participants, including neonatologists, NNPs, nurses, and patient families, reported high levels of satisfaction with the hybrid telemedicine model developed and implemented at this institution which may be comparable to in-person direct patient care. KEY POINTS · Implementation of a hybrid telemedicine system provides an alternative to the transfer of newborns needing advanced care to tertiary care facilities.. · In this study, both health care providers and patient family members were satisfied with the quality of care using hybrid telemedicine.. · In this study, families of newborns could fully participate in their child's care using the hybrid telemedicine system..
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Affiliation(s)
- Henry G Hallford
- Department of Pediatrics, Section of Neonatal and Perinatal Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Edgardo Szyld
- Department of Pediatrics, Section of Neonatal and Perinatal Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Michael McCoy
- Department of Pediatrics, Section of Neonatal and Perinatal Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Abhishek Makkar
- Department of Pediatrics, Section of Neonatal and Perinatal Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Rosenthal JL, Tancredi DJ, Marcin JP, Ketchersid A, Horath ET, Zerda EN, Bushong TR, Merriott DS, Romano PS, Young HM, Hoffman KR. Virtual family-centered hospital rounds in the neonatal intensive care unit: protocol for a cluster randomized controlled trial. Trials 2023; 24:331. [PMID: 37194089 DOI: 10.1186/s13063-023-07340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/29/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Family-centered rounds is recognized as a best practice for hospitalized children, but it has only been possible for children whose families can physically be at the bedside during hospital rounds. The use of telehealth to bring a family member virtually to the child's bedside during hospital rounds is a promising solution. We aim to evaluate the impact of virtual family-centered hospital rounds in the neonatal intensive care unit on parental and neonatal outcomes. METHODS This two-arm cluster randomized controlled trial will randomize families of hospitalized infants to have the option to use telehealth for virtual hospital rounds (intervention) or usual care (control). The intervention-arm families will also have the option to participate in hospital rounds in-person or to not participate in hospital rounds. All eligible infants who are admitted to this single-site neonatal intensive care unit during the study period will be included. Eligibility requires that there be an English-proficient adult parent or guardian. We will measure participant-level outcome data to test the impact on family-centered rounds attendance, parent experience, family-centered care, parent activation, parent health-related quality of life, length of stay, breastmilk feeding, and neonatal growth. Additionally, we will conduct a mixed methods implementation evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. DISCUSSION The findings from this trial will increase our understanding about virtual family-centered hospital rounds in the neonatal intensive care unit. The mixed methods implementation evaluation will enhance our understanding about the contextual factors that influence the implementation and rigorous evaluation of our intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05762835. Status: Not yet recruiting. First posted: March 10, 2023; last update posted: March 10, 2023.
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Affiliation(s)
- Jennifer L Rosenthal
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA.
- Center for Health and Technology, University of California Davis, 4610 X Street, Sacramento, CA, 95817, USA.
| | - Daniel J Tancredi
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - James P Marcin
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
- Center for Health and Technology, University of California Davis, 4610 X Street, Sacramento, CA, 95817, USA
| | - Audriana Ketchersid
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Elva T Horath
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Erika N Zerda
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Trevor R Bushong
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Daniel S Merriott
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Patrick S Romano
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
- Department of Internal Medicine and Center for Healthcare Policy and Research, University of California Davis, 4150 V St, Sacramento, CA, 95817, USA
| | - Heather M Young
- Betty Irene Moore School of Nursing, University of California Davis, 2570 48Th St, Sacramento, CA, 95817, USA
| | - Kristin R Hoffman
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
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8
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Rosenthal J, Tancredi D, Marcin J, Ketchersid A, Horath E, Zerda E, Bushong T, Merriott D, Romano P, Young H, Hoffman K. Virtual Family-Centered Rounds in the Neonatal Intensive Care Unit: Protocol for a Cluster Randomized Controlled Trial. RESEARCH SQUARE 2023:rs.3.rs-2644794. [PMID: 37131689 PMCID: PMC10153303 DOI: 10.21203/rs.3.rs-2644794/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background: Family-centered rounds is recognized as a best practice for hospitalized children, but it has only been possible for children whose families can physically be at the bedside during hospital rounds. The use of telehealth to bring a family member virtually to the child’s bedside during rounds is a promising solution. We aim to evaluate the impact of virtual family-centered rounds in the neonatal intensive care unit on parental and neonatal outcomes. Methods: This two-arm cluster randomized controlled trial will randomize families of hospitalized infants to have the option to use telehealth for virtual rounds (intervention) or usual care (control). The intervention-arm families will also have the option to participate in rounds in-person or to not participate in rounds. All eligible infants who are admitted to this single-site neonatal intensive care unit during the study period will be included. Eligibility requires that there be an English-proficient adult parent or guardian. We will measure participant-level outcome data to test the impact on family-centered rounds attendance, parent experience, family-centered care, parent activation, parent health-related quality of life, length of stay, breastmilk feeding, and neonatal growth. Additionally, we will conduct a mixed methods implementation evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Discussion: The findings from this trial will increase our understanding about virtual family-centered rounds in the neonatal intensive care unit. The mixed methods implementation evaluation will enhance our understanding about the contextual factors that influence the implementation and rigorous evaluation of our intervention. Trial registration: ClinicalTrials.gov Identifier: NCT05762835. Status: Not yet recruiting. First Posted: 3/10/2023; Last Update Posted: 3/10/2023.
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Tele-NICU: A Possible Solution for Bridging the ‘Gap’. Indian Pediatr 2023. [DOI: 10.1007/s13312-023-2816-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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10
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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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11
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Teng R, Ding Y, See KC. Use of Robots in Critical Care: Systematic Review. J Med Internet Res 2022; 24:e33380. [PMID: 35576567 PMCID: PMC9152725 DOI: 10.2196/33380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/22/2022] [Accepted: 03/06/2022] [Indexed: 01/01/2023] Open
Abstract
Background The recent focus on the critical setting, especially with the COVID-19 pandemic, has highlighted the need for minimizing contact-based care and increasing robotic use. Robotics is a rising field in the context of health care, and we sought to evaluate the use of robots in critical care settings. Objective Although robotic presence is prevalent in the surgical setting, its role in critical care has not been well established. We aimed to examine the uses and limitations of robots for patients who are critically ill. Methods This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Embase, IEEE Xplore, and ACM Library were searched from their inception to December 23, 2021. Included studies involved patients requiring critical care, both in intensive care units or high-dependency units, or settings that required critical care procedures (eg, intubation and cardiopulmonary resuscitation). Randomized trials and observational studies were included. Results A total of 33 studies were included. The greatest application of robots in the intensive care unit was in the field of telepresence, whereby robots proved advantageous in providing a reduced response time, earlier intervention, and lower mortality rates. Challenges of telepresence included regulatory and financial barriers. In therapy and stroke rehabilitation, robots achieved superior clinical outcomes safely. Robotic use in patient evaluation and assessment was mainly through ultrasound evaluation, obtaining satisfactory to superior results with the added benefits of remote assessment, time savings, and increased efficiency. Robots in drug dispensing and delivery increased efficiency and generated cost savings. All the robots had technological limitations and hidden costs. Conclusions Overall, our results show that robotic use in critical care settings is a beneficial, effective, and well-received intervention that delivers significant benefits to patients, staff, and hospitals. Looking ahead, it is necessary to form strong ethical and legislative frameworks and overcome various regulatory and financial barriers. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021234162; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=234162
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Affiliation(s)
- Rachel Teng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yichen Ding
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kay Choong See
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
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Griggs AC, Fausett CM, Simonson RJ, Williams KN, Bisbey TM, Lazzara EH, Keebler JR, DiazGranados D, Mishra VK, Thomas EJ, Salas E. Telerounding: A scoping review and implications for future healthcare practice. HUMAN FACTORS IN HEALTHCARE 2021; 1:100008. [PMID: 35983374 PMCID: PMC9384964 DOI: 10.1016/j.hfh.2022.100008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Telerounding is slated to become an important avenue for future healthcare practice. As utilization of telerounding is increasing, a review of the literature is necessary to distill themes and identify critical considerations for the implementation of telerounding. We provide evidence of the utility of telerounding and considerations to support its implementation in future healthcare practice based on a scoping review. METHOD We collected articles from nine scientific databases from the earliest dated available articles to August 2020. We identified whether each article centered on telerounding policies, regulations, or practice. We also organized information from each article and sorted themes into four categories: sample characteristics, technology utilized, study constructs, and research outcomes. RESULTS We identified 21 articles related to telerounding that fit our criteria. All articles emphasized telerounding practice. Most articles reported data collected from surgical wards, had adult samples, and utilized robotic telerounding systems. Most articles reported null effects or positive effects on their measured variables. DISCUSSION Providers and patients can benefit from the effective implementation of telerounding. Telerounding can support patient care by reducing travel expenses and opportunities for infection. Evidence suggests that telerounding can reduce patient length of stay. Patients and providers are willing to utilize telerounding, but patient willingness is influenced by age and education. Telerounding does not appear to negatively impact satisfaction or patient care. Organizations seeking to implement telerounding systems must consider education for their providers, logistics associated with hardware and software, scheduling, and characteristics of the organizational context that can support telerounding. Considerations provided in this article can mitigate difficulties associated with the implementation of telerounding.
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Affiliation(s)
- Andrew C Griggs
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Crystal M Fausett
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Richard J Simonson
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Kimberly N Williams
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Tiffany M Bisbey
- Department of Psychological Sciences, Rice University, Houston, TX, USA
| | - Elizabeth H Lazzara
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Joseph R Keebler
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | | | - Vimal K Mishra
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Eric J Thomas
- Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, TX, USA
| | - Eduardo Salas
- Department Chair, Department of Psychological Sciences, Rice University, Houston, TX, USA
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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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14
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Sierra Marín SD, Gomez-Vargas D, Céspedes N, Múnera M, Roberti F, Barria P, Ramamoorthy S, Becker M, Carelli R, Cifuentes CA. Expectations and Perceptions of Healthcare Professionals for Robot Deployment in Hospital Environments During the COVID-19 Pandemic. Front Robot AI 2021; 8:612746. [PMID: 34150856 PMCID: PMC8208489 DOI: 10.3389/frobt.2021.612746] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/31/2021] [Indexed: 12/18/2022] Open
Abstract
Several challenges to guarantee medical care have been exposed during the current COVID-19 pandemic. Although the literature has shown some robotics applications to overcome the potential hazards and risks in hospital environments, the implementation of those developments is limited, and few studies measure the perception and the acceptance of clinicians. This work presents the design and implementation of several perception questionnaires to assess healthcare provider's level of acceptance and education toward robotics for COVID-19 control in clinic scenarios. Specifically, 41 healthcare professionals satisfactorily accomplished the surveys, exhibiting a low level of knowledge about robotics applications in this scenario. Likewise, the surveys revealed that the fear of being replaced by robots remains in the medical community. In the Colombian context, 82.9% of participants indicated a positive perception concerning the development and implementation of robotics in clinic environments. Finally, in general terms, the participants exhibited a positive attitude toward using robots and recommended them to be used in the current panorama.
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Affiliation(s)
- Sergio D. Sierra Marín
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota, Colombia
| | - Daniel Gomez-Vargas
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota, Colombia
| | - Nathalia Céspedes
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota, Colombia
| | - Marcela Múnera
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota, Colombia
| | - Flavio Roberti
- Institute of Automatics, National University of San Juan, San Juan, Argentina
| | - Patricio Barria
- Club de Leones Cruz del Sur Rehabilitation Center, Punta Arenas, Chile
| | | | - Marcelo Becker
- Department of Mechanical Engineering, São Carlos School of Engineering, University of São Paulo, São Carlos, Brazil
| | - Ricardo Carelli
- Institute of Automatics, National University of San Juan, San Juan, Argentina
| | - Carlos A. Cifuentes
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota, Colombia
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15
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Lewis TT, Kim H, Darcy-Mahoney A, Waldron M, Lee WH, Park CH. Robotic Uses in Pediatric Care: A Comprehensive Review. J Pediatr Nurs 2021; 58:65-75. [PMID: 33360676 DOI: 10.1016/j.pedn.2020.10.016] [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] [Received: 07/29/2019] [Revised: 09/29/2020] [Accepted: 10/18/2020] [Indexed: 10/22/2022]
Abstract
PROBLEM Advances in technology have made robotics acceptable in healthcare and medical environments. The aim of this literature review was to examine how the pediatric population can benefit from robotic therapy and assistance that are currently available or being developed in diverse settings. ELIGIBILITY CRITERIA English language full-text publications focusing on pediatric robotic therapy studies for infants and children under the age of 17 indexed in PubMed and CINAHL and published from 2008 to 2018. SAMPLE A total of 272 articles were identified, 69 full-text articles were retrieved and assessed for eligibility, and 21 studies were finally used in the literature review. RESULTS From 21 studies, all studies reviewed showed that children benefited from robotic therapies were 1) responsive to the therapies and 2) favored robot's presence since the robotic systems increased their attention and ability to participate in tasks. Due to small sample size, results were statistically inconclusive. CONCLUSIONS We identified positive findings, where utilizing pediatric robots played vital roles in assisting and enhancing current pediatric and NICU treatments. Overall, our findings suggested that more clinical trials would be essential, but the uses of robots may contribute to the future advancement in pediatric and neonatal healthcare. IMPLICATIONS These review and analysis can be used to inform healthcare environments where there is a room for applying robotic assistance, although most studies required further testing with larger sample size to validate their results. This suggests the need for further research for robotics in pediatric and neonatal healthcare.
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Affiliation(s)
| | - Hyunji Kim
- Department of Biomedical Engineering, The George Washington University, DC, USA
| | | | | | - Won Hyong Lee
- Department of Computer Science, Handong University, Korea
| | - Chung Hyuk Park
- Department of Biomedical Engineering, The George Washington University, DC, USA.
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16
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Abstract
PURPOSE OF REVIEW Telehealth in neonatology is a rapidly expanding modality for providing care to neonatal patient populations. In this review, we describe the most recent published innovations in neonatal telehealth, spanning the neonatal ICU (NICU), community/rural hospitals and the patient's home. RECENT FINDINGS Telemedicine for neonatal subspecialty care has continued to expand, from well established uses in retinopathy of prematurity screening and tele-echocardiography, to applications in genetics and neurology. Within the NICU itself, neonatologist-led remote rounding has been shown to be a feasible method of increasing access to expert care for neonates in rural hospitals. Telehealth has improved parental and caregiver education, eased the NICU-to-home transition experience and expanded access to lactation services for rural mothers. Telemedicine-assisted neonatal resuscitation has improved the quality of resuscitation and reduced unnecessary neonatal transports to higher levels of care. Finally, the global COVID-19 pandemic has accelerated the expansion of neonatal telehealth. SUMMARY Telehealth provides increased access to expert neonatal care and improves patient outcomes, while reducing the cost of care for neonates in diverse settings. Continued high-quality investigation of the impacts of telehealth on patient outcomes and healthcare systems is critical to the continued development of neonatal telemedicine best practices.
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Affiliation(s)
| | - Kelli Lund
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Trang Huynh
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
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17
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Ahmed SN. Covid, AI, and Robotics-A Neurologist's Perspective. Front Robot AI 2021; 8:617426. [PMID: 33842556 PMCID: PMC8027242 DOI: 10.3389/frobt.2021.617426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/03/2021] [Indexed: 11/25/2022] Open
Abstract
Two of the major revolutions of this century are the Artificial Intelligence and Robotics. These technologies are penetrating through all disciplines and faculties at a very rapid pace. The application of these technologies in medicine, specifically in the context of Covid 19 is paramount. This article briefly reviews the commonly applied protocols in the Health Care System and provides a perspective in improving the efficiency and effectiveness of the current system. This article is not meant to provide a literature review of the current technology but rather provides a personal perspective of the author regarding what could happen in the ideal situation.
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Affiliation(s)
- Syed Nizamuddin Ahmed
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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18
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Chai PR, Dadabhoy FZ, Huang HW, Chu JN, Feng A, Le HM, Collins J, da Silva M, Raibert M, Hur C, Boyer EW, Traverso G. Assessment of the Acceptability and Feasibility of Using Mobile Robotic Systems for Patient Evaluation. JAMA Netw Open 2021; 4:e210667. [PMID: 33662134 PMCID: PMC8058534 DOI: 10.1001/jamanetworkopen.2021.0667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Before the widespread implementation of robotic systems to provide patient care during the COVID-19 pandemic occurs, it is important to understand the acceptability of these systems among patients and the economic consequences associated with the adoption of robotics in health care settings. OBJECTIVE To assess the acceptability and feasibility of using a mobile robotic system to facilitate health care tasks. DESIGN, SETTING, AND PARTICIPANTS This study included 2 components: a national survey to examine the acceptability of using robotic systems to perform health care tasks in a hospital setting and a single-site cohort study of patient experiences and satisfaction with the use of a mobile robotic system to facilitate triage and telehealth tasks in the emergency department (ED). The national survey comprised individuals living in the US who participated in a sampling-based survey via an online analytic platform. Participants completed the national survey between August 18 and August 21, 2020. The single-site cohort study included patients living in the US who presented to the ED of a large urban academic hospital providing quaternary care in Boston, Massachusetts between April and August 2020. All data were analyzed from August to October 2020. EXPOSURES Participants in the national survey completed an online survey to measure the acceptability of using a mobile robotic system to perform health care tasks (facilitating telehealth interviews, acquiring vital signs, obtaining nasal or oral swabs, placing an intravenous catheter, performing phlebotomy, and turning a patient in bed) in a hospital setting in the contexts of general interaction and interaction during the COVID-19 pandemic. Patients in the cohort study were exposed to a mobile robotic system, which was controlled by an ED clinician and used to facilitate a triage interview. After exposure, patients completed an assessment to measure their satisfaction with the robotic system. MAIN OUTCOMES AND MEASURES Acceptability of the use of a mobile robotic system to facilitate health care tasks in a hospital setting (national survey) and feasibility and patient satisfaction regarding the use of a mobile robotic system in the ED (cohort study). RESULTS For the national survey, 1154 participants completed all acceptability questions, representing a participation rate of 35%. After sample matching, a nationally representative sample of 1000 participants (mean [SD] age, 48.7 [17.0] years; 535 women [53.5%]) was included in the analysis. With regard to the usefulness of a robotic system to perform specific health care tasks, the response of "somewhat useful" was selected by 373 participants (37.3%) for facilitating telehealth interviews, 350 participants (35.0%) for acquiring vital signs, 307 participants (30.7%) for obtaining nasal or oral swabs, 228 participants (22.8%) for placing an intravenous catheter, 249 participants (24.9%) for performing phlebotomy, and 371 participants (37.1%) for turning a patient in bed. The response of "extremely useful" was selected by 287 participants (28.7%) for facilitating telehealth interviews, 413 participants (41.3%) for acquiring vital signs, 192 participants (19.2%) for obtaining nasal or oral swabs, 159 participants (15.9%) for placing an intravenous catheter, 167 participants (16.7%) for performing phlebotomy, and 371 participants (37.1%) for turning a patient in bed. In the context of the COVID-19 pandemic, the median number of individuals who perceived the application of robotic systems to be acceptable for completing telehealth interviews, obtaining nasal and oral swabs, placing an intravenous catheter, and performing phlebotomy increased. For the ED cohort study, 51 individuals were invited to participate, and 41 participants (80.4%) enrolled. One participant was unable to complete the study procedures because of a signaling malfunction in the robotic system. Forty patients (mean [SD] age, 45.8 [2.7] years; 29 women [72.5%]) completed the mobile robotic system-facilitated triage interview, and 37 patients (92.5%) reported that the interaction was satisfactory. A total of 33 participants (82.5%) reported that their experience of receiving an interview facilitated by a mobile robotic system was as satisfactory as receiving an in-person interview from a clinician. CONCLUSIONS AND RELEVANCE In this study, a mobile robotic system was perceived to be acceptable for use in a broad set of health care tasks among survey respondents across the US. The use of a mobile robotic system enabled the facilitation of contactless triage interviews of patients in the ED and was considered acceptable among participants. Most patients in the ED rated the quality of mobile robotic system-facilitated interaction to be equivalent to in-person interaction with a clinician.
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Affiliation(s)
- Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
- The Fenway Institute, Boston, Massachusetts
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge
| | - Farah Z Dadabhoy
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hen-Wei Huang
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jacqueline N Chu
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Annie Feng
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge
| | - Hien M Le
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge
| | - Joy Collins
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Chin Hur
- Division of Gastroenterology, Department of Medicine, Columbia University, New York, New York
| | - Edward W Boyer
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- The Fenway Institute, Boston, Massachusetts
| | - Giovanni Traverso
- Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge
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Brei BK, Gray MM, Umoren R, Handley S, DiGeronimo R, Sawyer T, Smith K, Billimoria Z. Interprofessional ECMO telerounding: a novel approach to neonatal ECMO clinical participation and education. J Perinatol 2021; 41:824-829. [PMID: 32963301 PMCID: PMC7505939 DOI: 10.1038/s41372-020-00827-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Determine the feasibility, strengths, and barriers of offering extracorporeal membrane oxygenation (ECMO) telerounding to neonatal intensive care unit (NICU) care providers. STUDY DESIGN NICU providers were invited to join ECMO rounds by teleconference. Data were collected on telerounding participation and ECMO concepts discussed. A survey was sent to all providers. RESULTS From March 2018 to February 2020, telerounding on 24 neonatal ECMO patients (168 ECMO days) was performed in a Level IV NICU. A mean of four providers joined telerounds per ECMO day with an increase from 3 to 6 providers over the study period. Nearly all respondents felt telerounding lowered barriers to attending ECMO rounds (94%), promoted engagement (89%), and improved continuity of care (78%). Barriers to ECMO telerounding were suboptimal audio connections and limited ability to participate in the clinical discussion. CONCLUSION ECMO telerounding is well-received by NICU providers. It can improve provider participation, complement existing in-person ECMO rounds, and ECMO education.
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Affiliation(s)
- Brianna K. Brei
- grid.34477.330000000122986657Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA USA
| | - Megan M. Gray
- grid.34477.330000000122986657Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA USA
| | - Rachel Umoren
- grid.34477.330000000122986657Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA USA
| | - Sarah Handley
- grid.34477.330000000122986657Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA USA
| | - Robert DiGeronimo
- grid.34477.330000000122986657Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA USA
| | - Taylor Sawyer
- grid.34477.330000000122986657Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA USA
| | - Kendra Smith
- grid.34477.330000000122986657Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA USA
| | - Zeenia Billimoria
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA.
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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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21
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Schwartz AM, Chan FJ, Levy BJ, Tarpada SP, Schwechter EM. Telerounding Offers High Patient Satisfaction After Total Joint Arthroplasty. HSS J 2020; 16:461-467. [PMID: 33173447 PMCID: PMC7646716 DOI: 10.1007/s11420-020-09813-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Research in surgical fields other than orthopedics has demonstrated high patient satisfaction with non-traditional telerounding modalities. QUESTIONS/PURPOSES We sought to determine patient satisfaction and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores of patients who experienced telerounding in the post-operative period after undergoing total joint arthroplasty (TJA). METHODS Fifty consecutive TJA patients were prospectively enrolled to receive telerounding. The patients were divided into two groups based on their satisfaction with telerounding. The HCAHPS scores of the patients who received telerounding were compared with 50 control patients. RESULTS Overall, the telerounding cohort had a positive reaction to telerounding. Comparing patients who were highly satisfied to those who were dissatisfied with telerounding, younger patients were found to be more frequently satisfied with telerounding. Compared with patients who did not receive telerounding, patients who experienced telerounding rated the hospital higher on a 10-point scale were more likely to recommend the hospital to others, more frequently believed their physicians treated them with courtesy and respect, and more often believed their physicians always listened to them carefully. CONCLUSION An overwhelming majority of our patients found telerounding using FaceTime enhanced their care while recovering post-operatively from TJA. Those patients were typically younger and had significantly higher HCAHPS scores, which potentially can enhance the physician-patient relationship.
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Affiliation(s)
- Andrew M. Schwartz
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA 30322 USA ,Emory University Orthopaedics & Spine Hospital, 1455 Montreal Rd. E., Tucker, GA 30084 USA
| | - Ferdinand J. Chan
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461 USA ,Department of Orthopaedics, Montefiore Medical Center, 1250 Waters Pl, Bronx, NY 10461 USA
| | - Benjamin J. Levy
- UBMD Orthopaedics & Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York, 4225 Genesee Street, Suite 400, Cheektowaga, NY 14225 USA
| | - Sandip P. Tarpada
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461 USA ,Department of Orthopaedics, Montefiore Medical Center, 1250 Waters Pl, Bronx, NY 10461 USA
| | - Evan M. Schwechter
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461 USA ,Department of Orthopaedics, Montefiore Medical Center, 1250 Waters Pl, Bronx, NY 10461 USA
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22
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Vilendrer S, Patel B, Chadwick W, Hwa M, Asch S, Pageler N, Ramdeo R, Saliba-Gustafsson EA, Strong P, Sharp C. Rapid Deployment of Inpatient Telemedicine In Response to COVID-19 Across Three Health Systems. J Am Med Inform Assoc 2020; 27:1102-1109. [PMID: 32495830 PMCID: PMC7314045 DOI: 10.1093/jamia/ocaa077] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To reduce pathogen exposure, conserve personal protective equipment, and facilitate health care personnel work participation in the setting of the COVID-19 pandemic, three affiliated institutions rapidly and independently deployed inpatient telemedicine programs during March 2020. We describe key features and early learnings of these programs in the hospital setting. METHODS Relevant clinical and operational leadership from an academic medical center, pediatric teaching hospital, and safety net county health system met to share learnings shortly after deploying inpatient telemedicine. A summative analysis of their learnings was re-circulated for approval. RESULTS All three institutions faced pressure to urgently standup new telemedicine systems while still maintaining secure information exchange. Differences across patient demographics and technological capabilities led to variation in solution design, though key technical considerations were similar. Rapid deployment in each system relied on readily available consumer-grade technology, given the existing familiarity to patients and clinicians and minimal infrastructure investment. Preliminary data from the academic medical center over one month suggested positive adoption with 631 inpatient video calls lasting an average (standard deviation) of 16.5 minutes (19.6) based on inclusion criteria. DISCUSSION The threat of an imminent surge of COVID-19 patients drove three institutions to rapidly develop inpatient telemedicine solutions. Concurrently, federal and state regulators temporarily relaxed restrictions that would have previously limited these efforts. Strategic direction from executive leadership, leveraging off-the-shelf hardware, vendor engagement, and clinical workflow integration facilitated rapid deployment. CONCLUSION The rapid deployment of inpatient telemedicine is feasible across diverse settings as a response to the COVID-19 pandemic.
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Affiliation(s)
- Stacie Vilendrer
- Department of Medicine, Stanford Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Birju Patel
- Department of Medicine, Stanford Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Whitney Chadwick
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine & Information Services Department, Stanford Children's Health
| | - Michael Hwa
- Department of Medicine, County of Santa Clara Health System, 751 S. Bascom Ave, San Jose, CA 95128, USA
| | - Steven Asch
- Department of Medicine, Stanford Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.,VA Center for Innovation to Implementation, 795 Willow, Menlo Park, CA 94025, USA
| | - Natalie Pageler
- Division of Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine & Information Services Department, Stanford Children's Health
| | - Rajiv Ramdeo
- Technology and Digital Solutions, Stanford Medicine, 300 Pasteur Drive, Palo Alto, CA, 94304, USA
| | | | - Philip Strong
- Administration, County of Santa Clara Health System, 751 S. Bascom Ave, San Jose, CA 95128, USA
| | - Christopher Sharp
- Department of Medicine, Stanford Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
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Umoren RA, Gray MM, Handley S, Johnson N, Kunimura C, Mietzsch U, Billimoria Z, Lo MD. In-Hospital Telehealth Supports Care for Neonatal Patients in Strict Isolation. Am J Perinatol 2020; 37:857-860. [PMID: 32268382 PMCID: PMC7356060 DOI: 10.1055/s-0040-1709687] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study is to determine the feasibility of "in-hospital" inpatient telemedicine within a children's referral hospital to facilitate inpatient care activities such as interprofessional rounding and the provision of supportive services such as lactation consultations to pediatric patients in strict isolation. To test the feasibility of in-hospital video telemedicine, a dedicated telemedicine device was set up in the patient's room. This device and the accompanying Bluetooth stethoscope were used by the health care team located just outside the room for inpatient rounding and consultations from supportive services. Video telemedicine facilitated inpatient care and interactions with support services, reducing the number of health care providers with potential exposure to infection and decreasing personal protective equipment use. In the setting of strict isolation for highly infectious viral illness, telemedicine can be used for inpatient care activities such as interprofessional rounding and provision of supportive services. KEY POINTS: · Telehealth supports patient care in isolation.. · Telehealth reduced health care provider exposures.. · Telehealth conserves personal protective equipment..
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Affiliation(s)
- Rachel A. Umoren
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington,Address for correspondence Rachel A. Umoren, MBBCh, MS Department of Pediatrics, Division of Neonatology1959 NE Pacific Street, Box 356320, Seattle, WA 98195
| | - Megan M. Gray
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Sarah Handley
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Nathaniel Johnson
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Christina Kunimura
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Digital Health Innovation, Seattle Children's Hospital, Seattle, Washington
| | - Ulrike Mietzsch
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Zeenia Billimoria
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Mark D. Lo
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle, Washington
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Scope of telemedicine in neonatology. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020. [PMID: 32434631 PMCID: PMC7389396 DOI: 10.7499/j.issn.1008-8830.2001135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There is a widespread shortage of physicians worldwide, especially in rural areas. This shortage is more prevalent when it comes to subspecialty care, even in developed countries. One way to provide access to specialty care is using technology via telemedicine. Telemedicine has evolved over the last two decades, and its use is becoming widespread in developed countries. However, its use in the neonatal population is still limited and practiced only in some centers. It is now apparent that telemedicine can be successfully used in the neonatal population for screening premature infants for retinopathy of prematurity, congenital heart disease, bedside clinical rounds, neonatal resuscitation with the support of a tertiary care hospital, and family support. This avoids unnecessary transfer and appears to provide the same quality of care that the baby would have received at the tertiary care facility. This approach also improves family satisfaction, as the baby and the mother are kept together, and reduces the cost of care. This review focuses on the use of telemedicine in neonatal care, concentrating on the main areas where telemedicine has been shown to be successful and effective, including the status of telemedicine in China.
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Advances in Neonatal Care: 20 Years, 1445 Manuscripts, and Countless Nurses Touched and Infants Impacted! Adv Neonatal Care 2020; 20:1-8. [PMID: 31985541 DOI: 10.1097/anc.0000000000000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Makkar A, McCoy M, Hallford G, Foulks A, Anderson M, Milam J, Wehrer M, Doerfler E, Szyld E. Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study. Telemed J E Health 2019; 26:176-183. [PMID: 30835166 PMCID: PMC7044771 DOI: 10.1089/tmj.2018.0262] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate the safety and efficacy of premature infant treatment managed by hybrid telemedicine versus conventional care. Methods: Prospective, noninferiority study comparing outcomes of premature infants at Comanche County Memorial Hospital's (CCMH) Level II neonatal intensive care unit (NICU) with outcomes at OU Medical Center's (OUMC) Level IV NICU. All 32–35 weeks gestational age (GA) infants admitted between May 2015 and October 2017 were included. Infants requiring mechanical ventilation >24 h or advanced subspecialty care were excluded. Outcome variables were: length of stay (LOS), respiratory support, and time to full per oral (PO) feeds. Parents at both centers were surveyed about their satisfaction with the care provided. Between-group comparisons were performed by using Chi-square or Fisher's exact test. LOS was assessed for normality by using the Shapiro–Wilk test, and robust regression was used to construct a multivariable regression model to test the independent effect of location on LOS. All analyses were performed by using SAS v. 9.3 (SAS Institute, Cary, NC). Results: Data from 85 CCMH and 70 OUMC neonates were analyzed. CCMH neonates had significantly shorter LOS, reached full PO feeds sooner, and had fewer noninvasive ventilation support days. Location had a significant independent effect (p = 0.001) on LOS while controlling for GA, gender, race, surfactant use, inborn/outborn status, and 5-min APGAR scores. CCMH patients had reduced LOS of 3.01 days (95% confidence interval 1.1–4.8) than OUMC patients. Eighty-five surveys at CCMH and 66 at OUMC were analyzed. Compared with CCMH, OUMC parents reported more travel distance difficulties. 92.5% reported telemedicine experience as good or excellent, whereas 1.5% reported it as poor. Conclusion(s): Hybrid telemedicine is a safe and effective way to extend intensive neonatal care to medically underserved areas. Parental satisfaction with use of hybrid telemedicine is high and comparable to conventional care.
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Affiliation(s)
- Abhishek Makkar
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Address correspondence to: Abhishek Makkar, MD, Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200 N Everett Drive, Oklahoma City, OK 73104-5410
| | - Mike McCoy
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Gene Hallford
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Arlen Foulks
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Michael Anderson
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jennifer Milam
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Marla Wehrer
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Erica Doerfler
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Edgardo Szyld
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Tomines A. Pediatric Telehealth: Approaches by Specialty and Implications for General Pediatric Care. Adv Pediatr 2019; 66:55-85. [PMID: 31230700 DOI: 10.1016/j.yapd.2019.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alan Tomines
- Department of Pediatrics, UCLA Geffen School of Medicine, Los Angeles, CA, USA; Enterprise Information Services, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Harbor-UCLA Medical Center, Torrance, CA, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
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Abstract
PURPOSE OF REVIEW Access to care for children requiring pediatric general or specialty surgery or trauma care who live in rural areas remains a challenge in the United States. RECENT FINDINGS The expertise of specialists in tertiary centers can be extended to rural and underserved areas using telemedicine. There are challenges to making these resources available that need to be methodically approached to facilitate appropriate relationships between hospitals and providers. Programs, such as the National Pediatric Readiness Project and the HRSA Emergency Medical Services for Children Program enhance the capability of the emergency care system to function optimally, keep children at the home hospital if resources are available, facilitate transfer of patients and relationship building, and develop necessary transfer protocols and guidelines between hospitals. SUMMARY Telehealth services have the potential to enhance the reach of tertiary care for children in rural and underserved areas where surgical and trauma specialty care is not readily available, particularly when used to augment the objectives of national programs.
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Oh CK, Kim KH, Jeong W, Han WK, Rha KH, Ahn B. Research on Patient Satisfaction of Robotic Telerounding: A Pilot Study in a Korean Population. Urology 2019; 130:205-208. [PMID: 31059727 DOI: 10.1016/j.urology.2019.04.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/09/2019] [Accepted: 04/23/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the efficacy and functionality of robotic telerounding among Korean patients using the RP-7 robot system and a questionnaire survey comparing the results of robotic telerounding and standard rounding in Korean patients. METHODS A total of 40 patients who underwent urologic minimally invasive video-assisted minilaparotomy surgery, laparoscopic and robotic surgery, and endoscopic surgery were recruited. The patients were divided into 2 groups - telerounding (20) and standard rounding (20) - and underwent robotic telerounding and standard rounding. We assessed the patients using a 24-item questionnaire to evaluate the efficacy and functionality of their hospital care. RESULTS The hospital factors such as self-rated health, assistance, and pain control scores showed no statistically significant differences between groups. Patient satisfaction showed a statistically significant difference in MD confidence, medical communication, explanation understanding, explanation satisfaction, mutual communication, and mutual response. In the telerounding group, participants were satisfied with the audio and video qualities and believed that the robotic telerounding provided better care, and 85% of patients preferred telerounding in the absence of the attending physician. CONCLUSION Robotic telerounding can provide efficient and cost-effective medical rounding by reducing inconvenience and labor cost with greater patient satisfaction with postoperative care. However, there is no statistically significant difference in the hospital factors and postoperative morbidity. In addition, the patients doubted that the robotic telerounding could replace standard rounding due to the Eastern culture.
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Affiliation(s)
- Cheol Kyu Oh
- Department of Urology, College of Medicine, Inje University, Pusan, Republic of Korea
| | - Kwang Hyun Kim
- Department of Urology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Wooju Jeong
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI
| | - Woong Kyu Han
- Department of Urology, Urologic Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Koon Ho Rha
- Department of Urology, Urologic Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bummo Ahn
- Department of Robotics and Virtual Engineering, University of Science and Technology, Daejeon, Republic of Korea; Robotics R&D Group, Korea Institute of Industrial Technology, Ansan, Republic of Korea.
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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: 30] [Impact Index Per Article: 6.0] [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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Impact of Synchronous Telemedicine Models on Clinical Outcomes in Pediatric Acute Care Settings: A Systematic Review. Pediatr Crit Care Med 2018; 19:e662-e671. [PMID: 30234678 DOI: 10.1097/pcc.0000000000001733] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the impact of synchronous telemedicine models on the clinical outcomes in pediatric acute care settings. DATA SOURCES Citations from EBM Reviews, MEDLINE, EMBASE, Global Health, PubMed, and CINAHL. STUDY SELECTION We identified studies that evaluated the impact of synchronous telemedicine on clinical outcomes between January 2000 and April 2018. All studies involving acutely ill children in PICUs, pediatric cardiac ICUs, neonatal ICUs, and pediatric emergency departments were included. Publication inclusion criteria were study design, participants characteristics, technology type, interventions, settings, outcome measures, and languages. DATA EXTRACTION Two authors independently screened each article for inclusion and extracted information, including telecommunication method, intervention characteristics, sample characteristics and size, outcomes, and settings. DATA SYNTHESIS Out of the 789 studies initially identified, 24 were included. The six main outcomes of interest published were quality of care, hospital and standardized mortality rate, transfer rate, complications and illness severity, change in medical management, and length of stay. The use of synchronous telemedicine results improved quality of care and resulted in a decrease in the transfer rate (31-87.5%) (four studies), a shorter length of stay (8.2 vs 15.1 d) (six studies), a change or reinforcement of the medical care plan, a reduction in complications and illness severity, and a low hospital and standardized mortality rate. Overall, the quality of the included studies was weak. CONCLUSIONS Despite the broad recommendations found for using telemedicine in pediatric acute care settings, high-quality evidence of its impacts is still lacking. Further robust studies are needed to better determine the clinical effectiveness and the associated impacts of telemedicine in pediatric acute care settings.
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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: 16] [Impact Index Per Article: 2.7] [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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Kiesle ED, Hooten P. Comparison of off-site and on-site on-call provider response times. Nursing 2018; 48:61-65. [PMID: 30045243 DOI: 10.1097/01.nurse.0000541406.64673.b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Elizabeth Diane Kiesle
- In Temple, Tex., Elizabeth Diane Kiesle is a clinical nurse at Scott & White Medical Center in Temple, Tex., and Phyllis Hooten is an RN at Baylor Scott & White Health
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Croghan SM, Carroll P, Reade S, Gillis AE, Ridgway PF. Robot Assisted Surgical Ward Rounds: Virtually Always There. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:982. [PMID: 29717953 DOI: 10.14236/jhi.v25i1.982] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND While an explosion in technological sophistication has revolutionized surgery within the operating theatre, delivery of surgical ward-based care has seen little innovation. Use of telepresence allowing off-site clinicians communicate with patients has been largely restricted to outpatient settings or use of complex, expensive, static devices. We designed a prospective study to ascertain feasibility and face validity of a remotely controlled mobile audiovisual drone (LUCY) to access inpatients. This device is, uniquely, lightweight, freely mobile and emulates 'human' interaction by swiveling and adjusting height to patients' eye-level. METHODS: Robot-assisted ward rounds(RASWR) were conducted over 3 months. A remotely located consultant surgeon communicated with patients/bedside teams via encrypted audiovisual telepresence robot (DoubleRoboticstm, California USA). Likert-scale satisfaction questionnaires, incorporating free-text sections for mixed-methods data collection, were disseminated to patient and staff volunteers following RASWRs. The same cohort completed a linked questionnaire following conventional (gold-standard) rounds, acting as control group. Data were paired, and non-parametric analysis performed. RESULTS: RASWRs are feasible (>90% completed without technical difficulty). The RASWR(n=52 observations) demonstrated face validity with strong correlations (r>0.7; Spearman, p-value <0.05) between robotic and conventional ward rounds among patients and staff on core themes, including dignity/confidentiality/communication/satisfaction with management plan. Patients (96.08%, n=25) agreed RASWR were a satisfactory alternative when consultant physical presence was not possible. There was acceptance of nursing/NCHD cohort (100% (n=11) willing to regularly partake in RASWR). CONCLUSION: RASWRs receive high levels of patient and staff acceptance, and offer a valid alternative to conventional ward rounds when a consultant cannot be physically present.
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Dol J, Delahunty-Pike A, Anwar Siani S, Campbell-Yeo M. eHealth interventions for parents in neonatal intensive care units: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:2981-3005. [PMID: 29219875 DOI: 10.11124/jbisrir-2017-003439] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND As technology becomes increasingly more advanced, particularly video technology and interactive learning platforms, some neonatal intensive care units are embracing electronic health (eHealth) technologies to enhance and expand their family-centered care environments. Despite the emergence of eHealth, there has been a lack of systematic evaluation of its effectiveness thus far. OBJECTIVES To examine the effect of eHealth interventions used in neonatal intensive care units on parent-related and infant outcomes. INCLUSION CRITERIA TYPES OF PARTICIPANTS This review considered studies that included parents or primary caregivers of infants requiring care in a neonatal intensive care unit. TYPES OF INTERVENTION(S) This review considered studies that evaluated any eHealth interventions in neonatal intensive care units, including education (e.g. web-based platforms, mobile applications); communication (e.g. videos, SMS or text messaging), or a combination of both. Comparators included no eHealth interventions and/or standard care. TYPES OF STUDIES Experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies, and analytical cross sectional studies were considered. OUTCOMES This review considered studies that included parent-related outcomes (use and acceptance, stress/anxiety, confidence, financial impact, satisfaction and technical issues) and neonatal outcomes (length of stay, postmenstrual age at discharge, parental presence and visits). SEARCH STRATEGY A systematic search was undertaken across four databases to retrieve published studies in English from inception to November 18, 2016. METHODOLOGICAL QUALITY Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI). DATA EXTRACTION Quantitative data were extracted from included studies independently by two reviewers using the standardized data extraction tool from JBI-SUMARI. DATA SYNTHESIS A comprehensive meta-analysis for all outcomes was not possible and data has been reported narratively for all outcomes. RESULTS Eight studies met inclusion criteria and were included in the review. The majority of the studies were low to very low quality. The study design and type of eHealth technology examined varied greatly. There appears to be growing interest in the topic as over half of the included studies were published within the past two years. Primary findings suggest parent acceptance and use of eHealth interventions but an unclear impact on neonatal outcomes, particularly on length of stay, a commonly reported neonatal outcome. Due to the variation in eHealth interventions, and heterogeneity across studies, meta-analysis was not possible. Numerous single studies and small sample sizes limited the degree of adequate strength to determine statistical differences across outcomes. CONCLUSIONS While heterogeneity across studies precluded meta-analysis, consistent trends across all studies examining parental acceptance of eHealth interventions indicate that parents are willing to accept eHealth interventions as part of their neonatal intensive care, suggesting that the incorporation and evaluation of eHealth interventions in the neonatal intensive care unit setting is warranted. Further high quality studies are needed with larger sample sizes to detect changes in outcomes. As eHealth intervention studies move beyond feasibility and implementation, there is a demand for randomized control trials to examine the effect of eHealth interventions on parent and neonatal outcomes compared to usual care. Future studies should consider reporting of outcomes using standardized measures which would allow comparison across eHealth interventions in subsequent reviews.
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Affiliation(s)
- Justine Dol
- Department of Health, Faculty of Health, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- Aligning Health Needs and Evidence for Transformative Change: a Joanna Briggs Institute Affiliated Group, Dalhousie University, Canada
| | | | - Sheren Anwar Siani
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Marsha Campbell-Yeo
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
- Aligning Health Needs and Evidence for Transformative Change: a Joanna Briggs Institute Affiliated Group, Dalhousie University, Canada
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Melton KR, Ni Y, Tubbs-Cooley HL, Walsh KE. Using Health Information Technology to Improve Safety in Neonatal Care: A Systematic Review of the Literature. Clin Perinatol 2017; 44:583-616. [PMID: 28802341 DOI: 10.1016/j.clp.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Health information technology (HIT) interventions may improve neonatal patient safety but may also introduce new errors. The objective of this review was to evaluate the evidence for use of HIT interventions to improve safety in neonatal care. Evidence for improvement exists for interventions like computerized provider order entry in the neonatal population, but is lacking for several other interventions. Many unique applications of HIT are emerging as technology and use of the electronic health record expands. Future research should focus on the impact of these interventions in the neonatal population.
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Affiliation(s)
- Kristin R Melton
- Division of Neonatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH 45229, USA.
| | - Yizhao Ni
- Division of Biomedical Informatics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7024, Cincinnati, OH 45229, USA
| | - Heather L Tubbs-Cooley
- Research in Patient Services, Division of Nursing, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11016, Cincinnati, OH 45229, USA
| | - Kathleen E Walsh
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7014, Cincinnati, OH 45229, USA
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Dol J, Delahunty-Pike A, Siani SA, Campbell-Yeo M. eHealth interventions for parents in neonatal intensive care units: a systematic review protocol. ACTA ACUST UNITED AC 2017; 15:1835-1849. [DOI: 10.11124/jbisrir-2016-003246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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