TeleNICU: Extending the reach of level IV care and optimizing the triage of patient transfers

2021 ◽  
pp. 1357633X2110381
Author(s):  
Jawahar Jagarapu ◽  
Vishal Kapadia ◽  
Imran Mir ◽  
Venkat Kakkilaya ◽  
Kristin Carlton ◽  
...  

Background The use of telemedicine to provide care for critically ill newborn infants has significantly evolved over the last two decades. Children's Health System of Texas and University of Texas Southwestern Medical Center established TeleNICU, the first teleneonatology program in Texas. Objective To evaluate the effectiveness of Tele Neonatal Intensive Care Unit (TeleNICU) in extending quaternary neonatal care to more rural areas of Texas. Materials and methods We conducted a retrospective review of TeleNICU consultations from September 2013 to October 2018. Charts were reviewed for demographic data, reasons for consultation, and consultation outcomes. Diagnoses were classified as medical, surgical, or combined. Consultation outcomes were categorized into transferred or retained. Transport cost savings were estimated based on the distance from the hub site and the costs for ground transportation. Results TeleNICU had one hub (Level IV) and nine spokes (Levels I–III) during the study period. A total of 132 direct consultations were completed during the study period. Most consultations were conducted with Level III units (81%) followed by level I (13%) and level II (6%) units. Some common diagnoses included prematurity (57%), respiratory distress (36%), congenital anomalies (25%), and neonatal surgical emergencies (13%). For all encounters, 54% of the patients were retained at the spoke sites, resulting in an estimated cost savings of USD0.9 million in transport costs alone. The likelihood of retention at spoke sites was significantly higher for medical diagnoses compared to surgical diagnoses (89% vs. 11%). Conclusion Telemedicine effectively expands access to quaternary neonatal care for more rural communities, helps in the triage of neonatal transfers, promotes family centered care, and significantly reduces health care costs.

Author(s):  
Jennifer L. Fang ◽  
Rachel Umoren ◽  
Hilary Whyte ◽  
Jamie Limjoco ◽  
Abhishek Makkar ◽  
...  

Objective We aimed to measure provider perspectives on the acceptability, appropriateness, and feasibility of teleneonatology in neonatal intensive care units (NICUs) and community hospitals. Study Design Providers from five academic tertiary NICUs and 27 community hospitals were surveyed using validated implementation measures to assess the acceptability, appropriateness, and feasibility of teleneonatology. For each of the 12 statements, scale values ranged from 1 to 5 (1 = strongly disagree; 5 = strongly agree), with higher scores indicating greater positive perceptions. Survey results were summarized, and differences across respondents assessed using generalized linear models. Results The survey response rate was 56% (203/365). Respondents found teleneonatology to be acceptable, appropriate, and feasible. The percent of respondents who agreed with each of the twelve statements ranged from 88.6 to 99.0%, with mean scores of 4.4 to 4.7 and median scores of 4.0 to 5.0. There was no difference in the acceptability, appropriateness, and feasibility of teleneonatology when analyzed by professional role, years of experience in neonatal care, or years of teleneonatology experience. Respondents from Level I well newborn nurseries had greater positive perceptions of teleneonatology than those from Level II special care nurseries. Conclusion Providers in tertiary NICUs and community hospitals perceive teleneonatology to be highly acceptable, appropriate, and feasible for their practices. The wide acceptance by providers of all roles and levels of experience likely demonstrates a broad receptiveness to telemedicine as a tool to deliver neonatal care, particularly in rural communities where specialists are unavailable. Key Points


Author(s):  
Jennifer L. Fang ◽  
Rachel A Umoren ◽  
Hilary Whyte ◽  
Jamie Limjoco ◽  
Abhishek Makkar ◽  
...  

Objective: We aimed to measure provider perspectives on the acceptability, appropriateness, and feasibility of teleneonatology in neonatal intensive care units (NICU) and community hospitals. Study Design: Providers from five academic tertiary NICUs and 27 community hospitals were surveyed using validated implementation measures to assess the acceptability, appropriateness, and feasibility of teleneonatology. For each of the twelve statements, scale values ranged from 1 to 5 (1=strongly disagree; 5=strongly agree), with higher scores indicating greater positive perceptions. Survey results were summarized, and differences across respondents assessed using generalized linear models. Results: The survey response rate was 56% (203/365). Respondents found teleneonatology to be acceptable, appropriate, and feasible. The percent of respondents who agreed with each of the twelve statements ranged from 88.6-99.0%, with mean scores of 4.4-4.7 and median scores of 4.0-5.0. There was no difference in the acceptability, appropriateness, and feasibility of teleneonatology when analyzed by professional role, years of experience in neonatal care, or years of teleneonatology experience. Respondents from Level I well newborn nurseries had greater positive perceptions of teleneonatology than those from Level II special care nurseries. Conclusion: Providers in tertiary NICUs and community hospitals perceive teleneonatology to be highly acceptable, appropriate, and feasible for their practices. The wide acceptance by providers of all roles and levels of experience likely demonstrates a broad receptiveness to telemedicine as a tool to deliver neonatal care, particularly in rural communities where specialists are unavailable.


2018 ◽  
Vol 104 (5) ◽  
pp. F528-F534 ◽  
Author(s):  
Maria C den Boer ◽  
Mirjam Houtlosser ◽  
Elizabeth E Foglia ◽  
Ratna N G B Tan ◽  
Dirk P Engberts ◽  
...  

ObjectiveTo assess benefits of recording and reviewing neonatal resuscitation as experienced by neonatal care providers.DesignA qualitative study using semistructured interviews questioning neonatal care providers about their experiences with recording and reviewing neonatal resuscitation. Data were analysed using the qualitative data analysis software Atlas.ti V.7.0.SettingNeonatal care providers working at neonatal intensive care units (NICUs) of the Leiden University Medical Center, the Netherlands, and the University of Pennsylvania School of Medicine, USA, participated in this study.ResultsIn total, 48 NICU staff members were interviewed. Reported experiences and attitudes are broadly similar for both NICUs. All interviewed providers reported positive experiences and benefits, with special emphasis on educational benefits. Recording and reviewing neonatal resuscitation is used for various learning activities, such as plenary review meetings and as tool for objective feedback. Providers reported to learn from reviewing their own performance during resuscitation, as well as from reviewing performances of others. Improved time perception, reflection on guideline compliance and acting less invasively during resuscitations were often mentioned as learning outcomes. All providers would recommend other NICUs to implement recording and reviewing neonatal resuscitation, as it is a powerful tool for learning and improving. However, they emphasised preconditions for successful implementation, such as providing information, not being punitive and focusing on the benefits for learning and improving.ConclusionRecording and reviewing neonatal resuscitation is considered highly beneficial for learning and improving resuscitation skills and is recommended by providers participating in it.


2016 ◽  
Vol 6 (3) ◽  
pp. 159-164 ◽  
Author(s):  
Molly Leach ◽  
Guadalupe Garcia ◽  
Nicole Ganzer

Abstract Introduction: The Veterans Health Administration is extending its mental health services to reach those in rural areas who find it difficult to travel to a Veterans Affairs Medical Center (VAMC). This project aimed to outline implementation of a Pharmacy Mental Health Clinical Video Telehealth (MHCVT) clinic for veterans. Secondary endpoints were to assess patient satisfaction with MHCVT, describe the potential benefits of this clinic regarding travel saved, and summarize no-show rates. Methods: Veterans received mental health disease state medication management from a mental health clinical pharmacy specialist via clinical video telehealth (CVT) in place of an in-clinic appointment and were asked to complete a satisfaction survey after the initial CVT appointment. Data collected from all veterans enrolled in the CVT clinic from September 8, 2014, through March 23, 2015 included: patient demographics, service connection percentage, number of CVT visits, travel miles saved, travel reimbursement, no-show rate, and documentation of medication management therapy. Results: As of March 23, 2015, there were 22 veterans enrolled in the MHCVT clinic, of whom, 19 completed their appointments. Of the 48 potential encounters, 7 were considered a no-show (17%). On average veterans saved 34 travel miles per visit with cumulative savings of 1432.6 miles. Of those who were eligible to receive travel reimbursement (n = 13), the medical center potentially saved $674.50 in a 7-month period. Overall clinic satisfaction per survey (n = 14) was 100% (strongly agreed or agreed). A majority (93%) would recommend the clinic to other veterans. Conclusions: This project successfully implemented a MHCVT pilot clinic. The veterans were satisfied with the services. The 41 clinic visits resulted in a potential cost savings. Expansion of this clinic in the future will expand more mental health resources to veterans.


2020 ◽  
pp. 1357633X2097291
Author(s):  
Sarah C Haynes ◽  
James P Marcin ◽  
Parul Dayal ◽  
Daniel J Tancredi ◽  
Stephanie Crossen

Background Children in rural communities often lack access to subspecialty medical care. Telemedicine has the potential to improve access to these services but its effectiveness has not been rigorously evaluated for paediatric patients with endocrine conditions besides diabetes. Introduction The purpose of this study was to assess the association between telemedicine and visit attendance among patients who received care from paediatric endocrinologists at an academic medical centre in northern California between 2009–2017. Methods We abstracted demographic data, encounter information and medical diagnoses from the electronic health record for patients ≤18 years of age who attended at least one in-person or telemedicine encounter with a paediatric endocrinologist during the study period. We used a mixed effects logistic regression model – adjusted for age, diagnosis and distance from subspecialty care – to explore the association between telemedicine and visit attendance. Results A total of 40,941 encounters from 5083 unique patients were included in the analysis. Patients who scheduled telemedicine visits were predominantly publicly insured (97%) and lived a mean distance of 161 miles from the children’s hospital. Telemedicine was associated with a significantly higher odds of visit attendance (odds ratio 2.55, 95% confidence interval 2.15–3.02, p < 0.001) compared to in-person care. Conclusions This study demonstrates that telemedicine is associated with higher odds of visit attendance for paediatric endocrinology patients and supports the conclusion that use of telemedicine may improve access to subspecialty care for rural and publicly insured paediatric populations.


Author(s):  
Wei Chen ◽  
Sidarto Bambang Oetomo ◽  
Loe Feijs

This chapter focuses on monitoring vital health parameters for a particular group of patients - critically ill newborn infants in neonatal intensive care units (NICU) at hospitals. These neonates are extremely tiny and vulnerable. Thus, health monitoring for the neonates provides crucial parameters for urgent diagnoses and corresponding medical procedures, subsequently increasing the survival rates. Neonatal monitoring is a multidisciplinary area which involves a unique integration of knowledge from medical science, design, technology and social study. In this chapter, the authors introduce current status and new developments in neonatal monitoring. They present some ongoing research examples of non-invasive neonatal monitoring designed and developed at the department of Industrial Design and the department of Electrical Engineering, Eindhoven University of Technology (TU/e) in collaboration with the department of neonatology, Máxima Medical Center (MMC), Veldhoven, in the Netherlands, including the first prototype smart jacket, a wireless power supply and video signal processing for neonatal monitoring. Challenges and social impacts of non-invasive neonatal monitoring will be discussed.


2003 ◽  
Vol 3 ◽  
pp. 1363-1369 ◽  
Author(s):  
Deena R. Zimmerman ◽  
Gil Klinger ◽  
Paul Merlob

The increased frequency of early discharge of newborns has led to questions of its safety. Most studies have looked at mortality and rehospitalization, not all missed diagnoses. The purpose of this study was to determine diagnoses in newborn infants that would have been missed if the infant had been discharged in <24 h. The design was a cohort study at Rabin Medical Center-Beilinson Campus (average monthly deliveries 1996 [250], 1997 [500]), a university-affiliated community hospital with all in-born term (≥37 weeks) infants born September through November 1996 and June 1997.The main outcome measures were medical diagnoses (except trivial physical descriptions) noted at discharge (generally at ≥48 h) exam, not noted on admission exam (<24 h).The results showed that 54 infants (5.1%) had diagnoses that were not detected before the infant was 24 h of age. The leading diagnosis was hyperbilirubinemia. Other potentially missed diagnoses included congenital heart disease (n = 10), morbidity of birth trauma (n = 9), metabolic disturbances (n = 2), hip dislocation (n = 1), suspected sepsis (n = 2), excessive weight loss (n = 2), polycythemia (n = 2), inguinal hernia (n = 1), and abducens paresis (n = 1).It is concluded that diagnoses can be missed by discharging infants in 24 h or less. These diagnoses have the potential for adverse sequela. Even if early discharge is felt to be cost effective, parents should be counseled that it is not risk free. Better mechanisms should be put in place for assuring the safety of such infants.


2020 ◽  
Vol 3 (1) ◽  
pp. 14-19
Author(s):  
Hendra Permana

Introduction: The Knowledge, perception and attitude about epilepsy in developing country, including Indonesia is still low. These problems can cause stigma and discrimination to the patient. Society still has the view that epilepsy is not a disease, but because of the inclusion of evil spirits, possessions, witches or a curse. Furthermore, the information gap between rural and urban society could contribute to the issues. Aims: This study was aimed to explore the knowledge, perception and attitude about epilepsy between rural and urban society in Padang. Method: This study used cross sectional comparative design. This study was conducted on February – June 2018 at Ulak Karang (urban) and Bungus (rural) public health center. The subjects of this study were 140 visitors of both public health centers. The inclusions criteria of this study was all visitors ≥ 17 years old and the exclusion criteria was all incomplete data. Data was taken by using questionnaire with 13 close questions. These data was analyzed with SPSS 22. Mannwhitney tests and Chi Square test were used to compare the knowledge, perception and attitude from the two groups. A P value below 0.05 was considered asstatistically significant. Result: From demographic data, there were no significant differences between urban and rural communities. In terms of knowledge about epilepsy, there are significant differences regarding the causes of epilepsy with a value of p = 0.002. In addition, perceptions of epilepsy stigma that differed significantly in urban and rural communities were regarding malformations in epilepsy patients with p = 0.046. As for community attitudes towards epilepsy patients, there were no significant differences between urban and rural areas Conclusion: Stigma is a frightening thing for people with epilepsy, because it can interfere with their social interactions and also reduce the opportunity to get a job and also the opportunity to get married.  


Author(s):  
Felix Limbach ◽  
Hannes Kuebel ◽  
Rüdiger Zarnekow

The utilization of deployment synergies across infrastructure networks of different industries has been identified as a key to improve the broadband business case. Thus, an increasing number of broadband plans require owners of physical infrastructures such as the electricity, pipeline, highway and railroad networks to host broadband infrastructure. However, cross-industry cooperation brings about new complexity to optimal utilization of deployment synergies.This paper explores cost savings that can be achieved if national non-telecommunication infrastructures are considered as source for broadband networks in rural areas. Moreover, it assesses economic, political and regulatory measures required for improving synergy utilization. The presented approach is based on a techno-economic broadband deployment model, which is applied to all rural communities in Germany. Results indicate that synergy optimized network topologies can generally decrease rural broadband deployment cost. However, it is required that local authorities recognize the definition of broadband tender areas as a chance for the aggregation of demand. Moreover, national regulators need to ensure that metro-aggregation, backbone and co-location costs, which are associated with non-telecommunication infrastructures, do not exceed the costs of the incumbent by more than 50%.


Author(s):  
Remus Runcan

According to Romania’s National Rural Development Programme, the socio-economic situation of the rural environment has a large number of weaknesses – among which low access to financial resources for small entrepreneurs and new business initiatives in rural areas and poorly developed entrepreneurial culture, characterized by a lack of basic managerial knowledge – but also a large number of opportunities – among which access of the rural population to lifelong learning and entrepreneurial skills development programmes and entrepreneurs’ access to financial instruments. The population in rural areas depends mainly on agricultural activities which give them subsistence living conditions. The gap between rural and urban areas is due to low income levels and employment rates, hence the need to obtain additional income for the population employed in subsistence and semi-subsistence farming, especially in the context of the depopulation trend. At the same time, the need to stimulate entrepreneurship in rural areas is high and is at a resonance with the need to increase the potential of rural communities from the perspective of landscape, culture, traditional activities and local resources. A solution could be to turn vegetal and / or animal farms into social farms – farms on which people with disabilities (but also adolescents and young people with anxiety, depression, self-harm, suicide, and alexithymia issues) might find a “foster” family, bed and meals in a natural, healthy environment, and share the farm’s activities with the farmer and the farmer’s family: “committing to a regular day / days and times for a mutually agreed period involves complying with any required health and safety practices (including use of protective clothing and equipment), engaging socially with the farm family members and other people working on and around the farm, and taking on tasks which would include working on the land, taking care of animals, or helping out with maintenance and other physical work”


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