The first study to examine the effectiveness of telemedicine consultations for newborn resuscitation demonstrates the technology’s strengths and weaknesses, according to Mayo Clinic researchers.
One of the strengths is that telemedicine consultations can improve the quality of care in local hospitals, possibly reducing the necessity of transfers to hospitals with higher levels of care, said the study published in the December 2016 issue of Mayo Clinic Proceedings. After the telemedicine consultation, a third (27 of 84) of the infants with breathing problems were treated in the local hospital.
“If the remote neonatologist had not been able to visually assess the newborn and provide remote-guided care, many of these infants may have otherwise been transferred to the NICU unnecessarily,” the study stated.
And money was saved. Helicopter transfers to higher-level neonatal intensive care units would have cost anywhere from $12,000 to $25,000, according to lead author Jennifer Fang, MD, and her colleagues in Mayo’s Division of Neonatal Medicine.
The 84 consultations for high-risk deliveries at six local hospitals were conducted between March 16, 2013, and Dec. 1, 2015. The hospitals in the study are 40 to 120 miles from the main Mayo Clinic Hospital in Rochester, Minn.
Among the problems identified in the study was the amount of time that lapsed between the incoming phone call and establishment of a video connection. On average, it took nine minutes, when it should happen in less than five minutes, said the authors. They suggested that process improvements, such as revising call triage algorithms, would help deal with this problem.
But there were also problems with the equipment and connectivity. When the neonatologists and referring providers were surveyed, 25% (16 of 64) rated the audio quality as poor or unusable, and 19% (12 of 64) put the video quality in that category.
Fang and her colleagues noted that “time-critical” telemedicine needs simple and highly reliable video technology and that the wireless mobile devices used by the community providers didn’t meet those requirements, as evidenced by the difficulty establishing and maintaining a video connection. “These issues were likely due to multiple factors, including insufficient wireless network bandwidth, user error, and software upgrades that changed the user interface or required action before the consult,” they said.
They also sounded an optimistic note, though, concluding that “with the appropriate telemedicine technologies, high levels of agreement between remote physicians can be achieved on multiple physical examination findings, including genetic and neurologic examinations.”
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