Mayo Clinic uses emergency telemedicine for newborn resuscitations

Video consults between Mayo’s neonatologists and community hospitals provide much-needed support during neonatal emergencies, but technology is not without glitches.

The Mayo Clinic is using emergency video telemedicine to effectively assist community hospitals less familiar with advanced newborn resuscitation interventions during high-risk, complex deliveries.

Mayo’s Division of Neonatal Medicine initially offered newborn telemedicine consultations to six of its health system sites, where local care teams used wireless tablets running HIPAA-compliant video conferencing software from Vidyo to communicate with neonatologists at Mayo in Rochester, Minn. Video consults are now conducted at all 10 of Mayo’s health system sites that deliver babies in the Rochester region.

The technology enables neonatologists to “visually assess the babies and co-manage them together with local care teams more efficiently using video and improved communication,” says Jennifer Fang, MD, a Mayo Clinic fellow in neonatal-perinatal medicine. “With telemedicine now, we’re able to bring our neonatologists to the bedside remotely to really help guide these local care teams with complex deliveries.”

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The vast majority of babies are fine after delivery, but about 10 percent of newborns require some help breathing after birth, while 1 in 1,000 require more intensive resuscitation measures, Fang notes. Although these high-risk deliveries often present challenges to community hospitals, Mayo’s telemedicine consultation for neonatal resuscitation have improved access to neonatology expertise and prevented unnecessary transfers to facilities that offer higher levels of care, she contends.

Over a 20-month period, Mayo conducted 84 newborn telemedicine consultations, with prematurity cited as the most frequent reason for the consult, followed by respiratory distress and need for advanced resuscitation. In more than 93 percent of 64 surveyed cases, the local provider agreed that the telemedicine consult improved patient safety, quality of care, or both.

“The most significant finding was that with the use of this technology, about one-third of the babies were able to remain in the local hospital with their families after the consult,” says Fang, who adds that the potential cost savings can be substantial. “It’s a win-win situation in which we provide the right level of care to the patient at the right location. That way, we’re using our neonatal ICU beds at Mayo for babies who are critically ill and need that level of care.”

Writing in a recent issue of Mayo Clinic Proceedings, which published the results of their study, Fang and her colleagues noted that providers who participated in the telemedicine consults responded positively to surveys that assessed teamwork and the impact on patient safety and quality of care, as well as the collaboration between the local on-site care teams and Mayo’s remote neonatologists.

Nonetheless, the community hospitals—two have a level II newborn nursery, and the other four hospitals have a level I nursery—had some issues with the video telemedicine technology. User assessments of the technology showed that audio and video quality were poor or unusable in 16 (25 percent) and 12 (18.8 percent) of cases, respectively. In addition, providers failed to establish a video connection during eight consults (9.5 percent).

“Time-critical telemedicine consults require simple, fast, highly reliable video telemedicine technology,” states the article. “The wireless mobile device used by our community providers did not meet these requirements, as illustrated by the unacceptable number of difficulties 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 initiating the consult.”

Software vendor Vidyo was not immediately available for comment.

Fang and her colleagues conclude that a “highly reliable technology infrastructure that provides high-quality audio and video should be considered for any emergency telemedicine service.”

The authors also note that the “wireless tablet with built-in microphone, speaker and camera was not able to deliver the full duplex audio or high-definition video required.” Because of the “poor reliability and audio/video quality of the technology,” they relate that Mayo Clinic has transitioned the emergency telemedicine platform for newborn resuscitations to a wired solution.

“Local teams now use a wired telemedicine cart that is equipped with a high-definition camera with pan/tilt/zoom capabilities that can be remotely controlled by the neonatologist,” states the article. “The cart also has an integrated noise-canceling, full-duplex microphone and speaker set.”

Going forward, Fang says Mayo is looking to better assess the clinical impact of telemedicine consultations on the quality of newborn resuscitations in the community setting as part of a retrospective study, and then partner with other health systems to study the technology.

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