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Emergency Video Telemedicine Consultation for Newborn Resuscitations

The Mayo Clinic Experience
Published:November 22, 2016DOI:https://doi.org/10.1016/j.mayocp.2016.08.006

      Abstract

      Objective

      To describe the Mayo Clinic experience with emergency video telemedicine consultations for high-risk newborn deliveries.

      Patients and Methods

      From March 26, 2013, through December 31, 2015, the Division of Neonatal Medicine offered newborn telemedicine consultations to 6 health system sites. A wireless tablet running secure video conferencing software was used by the local care teams. Descriptive data were collected on all consultations. After each telemedicine consult, a survey was sent to the neonatologist and referring provider to assess the technology, teamwork, and user satisfaction.

      Results

      During the study, neonatologists conducted 84 telemedicine consultations, and 64 surveys were completed. Prematurity was the most frequent indication for consultation (n=32), followed by respiratory distress (n=15) and need for advanced resuscitation (n=14). After the consult, nearly one-third of the infants were able to remain in the local hospital. User assessment of the technology revealed that audio and video quality were poor or unusable in 16 (25%) and 12 (18.8%) of cases, respectively. Providers failed to establish a video connection in 8 consults (9.5%). Despite technical issues, providers responded positively to multiple questions assessing teamwork (86.0% [n=37 of 43] to 100.0% [n=17 of 17] positive responses per question). In 93.3% (n=14 of 15) of surveyed cases, the local provider agreed that the telemedicine consult improved patient safety, quality of care, or both.

      Conclusion

      Telemedicine consultation for neonatal resuscitation improves patient access to neonatology expertise and prevents unnecessary transfers to a higher level of care. A highly reliable technology infrastructure that provides high-quality audio and video should be considered for any emergency telemedicine service.

      Abbreviations and Acronyms:

      ATC (admission and transfer center), CPAP (continuous positive airway pressure), CPR (cardiopulmonary resuscitation), ETT (endotracheal tube), HIE (hypoxic ischemic encephalopathy), NA (not applicable), NICU (neonatal intensive care unit), PEEP (positive end-expiratory pressure), PIP (peak inspiratory pressure), PPV (positive pressure ventilation)
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