A Hybrid Form of Telemedicine: A Unique Way to Extend Intensive Care Service to Neonates in Medically Underserved Areas

Makkar, Abhishek; McCoy, Mike; Hallford, Gene; Escobedo, Marilyn; Szyld, Edgardo

doi:10.1089/tmj.2017.0155

Cited by 35 publications

(28 citation statements)

References 13 publications

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“…Second, we speculate that nursing assignments at the Level IV NICU could be In a recently published study, our group reported similar favorable outcome measures with telemedicine use. 24 Our previous study was retrospective and did not assess parental satisfaction or transport cost savings. To our knowledge, there is only one reported prospective trial on the use of telemedicine for rounding in NICU.…”

Section: Discussionmentioning

confidence: 99%

“…Previous experience with this population indicated and expected mean LOS of 15 days with a standard deviation of 4 days. 24 A sample of 230 (115 telemedicine, 115 reference) will have 80% power to establish noninferiority in LOS for the telemedicine group by using a noninferiority margin of 0.1, which indicated a 10% difference in LOS. Parents at both centers were surveyed about their satisfaction with the care provided by utilizing a 10-question survey (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…[16][17][18][19][20][21][22] To date, few studies report telemedicine use as a primary means of providing care to premature infants in the NICU. 23,24 Our current prospective study was designed to evaluate the safety and efficacy of the treatment of premature infants managed by a hybrid telemedicine system in a satellite Level II NICU at Comanche County Memorial Hospital (CCMH) in Lawton, Oklahoma, compared with conventional management provided to a similar population in a regional Level IV NICU at OU Medical Center (OUMC) in Oklahoma City.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study

Makkar

McCoy

Hallford

et al. 2020

Telemedicine and e-Health

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study

Makkar

McCoy

Hallford

et al. 2020

Telemedicine and e-Health

Self Cite

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“…Telemedicine has been used in neonatal care since 1998 when the technology was first used in North Queensland, Australia to unite babies in the neonatal intensive care unit (NICU) with their mothers and families across long distances [ 9 ]. Recently, many studies have shown the benefit of telemedicine in regards to neonatal resuscitation care [ 10 ], rounds [ 11 , 12 ], simulation education [ 13 ], and NICU follow-up care [ 14 ]. In pediatric ECMO care, telemedicine has been used for provider to provider consultation [ 15 ], but these reports have not focused on provider clinical participation in the care of ECMO patients.…”

Section: Introductionmentioning

confidence: 99%

Interprofessional ECMO telerounding: a novel approach to neonatal ECMO clinical participation and education

et al. 2020

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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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“…Telemedicine support has reduced the need to transfer up to 85% of potential patients and shortened the time to definitive transfer of more critical patients [ 63 , 64 ]. Improved ICU outcomes with decreased mortality and shorter length of stay were reported following telemedicine neonatal and pediatric ICU support [ 65 , 66 ]. Teleradiology has been shown to decrease repeat imaging, cost, delays in care and radiation exposure [ 67 ].…”

mentioning

confidence: 99%

The Right Child/Right Surgeon initiative: A position statement on pediatric surgical training, sub-specialization, and continuous certification from the American Pediatric Surgical Association

Alaish

Powell

Waldhausen

et al. 2020

Journal of Pediatric Surgery

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The past 50 years have witnessed profound changes in the specialty of pediatric surgery in North America. There has been a marked increase in the number of both pediatric surgical training programs and practicing pediatric general and thoracic surgeons. Despite this trend, the population of children in the United States and the birth rate have recently remained relatively flat. Some pediatric surgeons have become “super specialists”, concentrating their practices in oncology or colorectal surgery. This has the potential to result in a dilution of experience for both pediatric surgical trainees and practicing pediatric surgeons, thus limiting their ability to acquire and maintain expertise, respectively. Coincident with this, there has been a relative paradigm shift in recognition that “quality of life” is based more on maintaining a creative balance in lifestyle and is not “all about work”. There has been a parallel growth in the number of practicing pediatric general and thoracic surgeons in urban settings, but we have not appreciated as much growth in rural and underserved areas, where access to pediatric surgical care remains limited and fewer pediatric general and thoracic surgeons practice. This is a complex issue, as some underserved areas are economically depressed and geographically sparse, but others are just underserved with adult providers taking care of children in settings that are often under resourced for pediatric surgical care. This problem may extend beyond the boundaries of pediatric general and thoracic surgery to other specialties. As the premier association representing all pediatric surgeons in the United States, the American Pediatric Surgical Association (APSA) has concluded that the quality of pediatric surgical care will likely decline should the status quo be allowed to continue. Therefore, APSA has initiated a Right Child/Right Surgeon initiative to consider these issues and propose some potential solutions. What follows is a brief statement of intent.

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A Hybrid Form of Telemedicine: A Unique Way to Extend Intensive Care Service to Neonates in Medically Underserved Areas

Abstract: The hybrid telemedicine system is a safe and effective strategy for extending intensive care to neonates in medically underserved areas.

Cited by 35 publications

References 13 publications

Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study

Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study

Interprofessional ECMO telerounding: a novel approach to neonatal ECMO clinical participation and education

The Right Child/Right Surgeon initiative: A position statement on pediatric surgical training, sub-specialization, and continuous certification from the American Pediatric Surgical Association

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