The Impact of Telemedicine on Transfer Rates of Newborns at Rural Community Hospitals

Haynes, Sarah C.; Dharmar, Madan; Hill, Barry C.; Hoffman, Kristin; Donohue, Lee; Kuhn-Riordon, Kara M.; Rottkamp, Catherine A.; Vali, Payam; Tancredi, Daniel J.; Romano, Patrick S.; Steinhorn, Robin H.; Marcin, James P.

doi:10.1016/j.acap.2020.02.013

Cited by 36 publications

(27 citation statements)

References 25 publications

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“…In this study, neonatal experts were called to assist with the most acute maternal, fetal, and newborn conditions. Although higher-risk newborns are represented in the VAR group, VAR is associated with fewer transfers and supports prior studies that telehealth consults are associated with reduced transfer rates (11,13). Additionally, VAR newborns transferred within the first 24 h of life had a LOS reduction of 2.21 h. A benefit of telehealth is that patients can be more efficiently triaged to the appropriate level of care when specialists are involved with their care (15,21).…”

Section: Linear Regression Was Used To Assess the Effect Of The Var Intervention On These Outcomes Unless Noted Otherwisesupporting

confidence: 72%

“…Early in the implementation, NICU hub neonatologists and spoke sites shared anecdotal stories of successful VAR, preventing transfers, and increasing confidence in their ability to conduct a newborn resuscitation. This study was informed from early implementation success stories, Intermountain and UC Davis studies on reduced transfer rates, and improved resuscitation quality reported by Randall Children's Hospital and the Mayo Clinic (9,(11)(12)(13). This study's primary aim was to determine the influence of a neonatologist VAR on transfers to a NICU, birth facility length of stay, This study's primary aim was to determine the influence of a neonatologist VAR on transfers to a newborn intensive care unit (NICU), birth facility length of stay, and days of life on supplemental oxygen.…”

Section: Introductionmentioning

confidence: 99%

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Implementation and Outcomes of a Telehealth Neonatology Program in a Single Healthcare System

et al. 2021

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Background: Intermountain Healthcare, an early adopter and champion for newborn video-assisted resuscitation (VAR), identified a reduction in facility-level transfers and an estimated savings of $1. 2 million in potentially avoided transfers in a 2018 study. This study was conducted to increase understanding of VAR at the individual, newborn level.Study Aim: To compare transfers to a newborn intensive care unit (NICU), length of stay (LOS), and days of life on oxygen between newborns managed by neonatal VAR and those receiving standard care (SC).Methods: This retrospective, nonequivalent group study includes infants born in an Intermountain hospital between 2013 and 2017, 34 weeks gestation or greater, and requiring oxygen support in the first 15 minutes of life. Data came from billing and clinical records from Intermountain's enterprise data warehouse and chart reviews. We used logistic regression to estimate neonatal VAR's impact on transfers. Negative binomial regression estimated the impact on LOS and days of life on supplemental oxygen.Results: The VAR intervention was used in 46.2 percent of post-implementation cases and is associated with (1) a 12 percentage points reduction in the transfer rate, p = 0.02, (2) a reduction in spoke hospital (SH) LOS of 8.33 h (p < 0.01) for all transfers; (3) a reduction in SH LOS of 2.21 h (p < 0.01) for newborns transferred within 24 h; (4) a reduction in SH LOS of 17.85 h (p = 0.06) among non-transferred newborns; (5) a reduction in days of life on supplemental oxygen of 1.4 days (p = 0.08) among all transferred newborns, and (6) a reduction in days of life on supplemental oxygen of 0.41 days (p = 0.04) among non-transferred newborns.Conclusion: This study provides evidence that neonatal VAR improves care quality and increases local hospitals' capabilities to keep patients close to home. There is an ongoing demand for support to rural and community hospitals for urgent newborn resuscitations, and complex, mandatory NICU transfers. Efforts may be necessary to encourage neonatal VAR since the intervention was only used in 46.2 percent of this study's potential cases. Additional work is needed to understand the short- and long-term impacts of Neonatal VAR on health outcomes.

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Section: Linear Regression Was Used To Assess the Effect Of The Var Intervention On These Outcomes Unless Noted Otherwisesupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Implementation and Outcomes of a Telehealth Neonatology Program in a Single Healthcare System

et al. 2021

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“…The rapid upscale of telehealth may provide a unique opportunity to support the provision of pediatric care within local communities. 12,13 As many general hospitals do not have ultrasound technicians trained for children available 24 hours per day, several conditions that fell into the advanced intervention category, like abdominal pain, were driven by the receipt of an ultrasound at the accepting hospital. Targeted work to expand ultrasound capabilities at referring hospitals may enable changing the categorization of an ultrasound to a basic intervention rather than an advanced intervention.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Conditions Requiring Minimal Intervention or Observation After Interfacility Transfer

McDaniel

Leyenaar

Sullivan³

et al. 2021

J Hosp Med

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Increasing regionalization of pediatric care has led to interfacility transfer of children with general pediatric conditions at rates similar to those of high-risk adults, which may delay appropriate treatment. We sought to identify common medical diagnoses that did not require significant advanced intervention and that had high rates of discharge within 1 day of interfacility transfer. Using the Pediatric Health Information System (PHIS) database, we identified all transfers into PHIS-participating children’s hospitals in 2019. We excluded encounters for mental health, labor/maternity, primary newborn diagnoses, and direct admissions to an intensive care unit. Eligible encounters were categorized by duration of hospitalization and basic vs advanced intervention after transfer. Of 286,905 transfers, 197,386 (68.6%) met inclusion criteria. Cough, febrile seizures, croup, and allergic reactions required advanced interventions <10% of the time, and patients with these diagnoses were most commonly discharged within 1 day after transfer. These conditions are potential targets for building pediatric capacity in non-pediatric hospitals.

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“…Until the coronavirus pandemic, they saw 4IR as an ally for providing them with technology that allowed them to improve their diagnoses and further increase their prestige. However, the IBM cognitive intelligence system employed at Dr. Watson Healthcare and the lobby for the deployment of telemedicine in some countries were already signs of what was to come ( Barney et al, 2020 ; Cremades et al, 2020 ; Haynes et al, 2020 ). Fear of coronavirus contamination has caused many doctors to practice social isolation.…”

Section: Section 1 – Physical Component Of 4ir Catalyzed By Coronavirmentioning

confidence: 99%

The fourth industrial revolution and the coronavirus: a new era catalyzed by a virus

Neto¹,

Maia²,

Neiva³

et al. 2020

Research in Globalization

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The global pandemic caused by the new coronavirus, COVID 19, has disrupted the lives of most people on the planet. The magnitude of such disruption can only be compared to those caused by World War II. Experts suggest that in order to better evaluate this situation, it should be divided into two waves. The first wave being associated with health issues and the second one with economic issues. This article suggests that this global pandemic is fostering yet a third wave, which in the long run can be much more impactful in our lives than the first two. This third wave consists on accelerating the implantation process of the fourth industrial revolution. This article is divided into sections with the physical, digital and biological spheres of the fourth industrial revolution, as well as the dimensions of sustainability and other important considerations, in order to better demonstrate the emergence of a new era catalyzed by a virus.

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The Impact of Telemedicine on Transfer Rates of Newborns at Rural Community Hospitals

Cited by 36 publications

References 25 publications

Implementation and Outcomes of a Telehealth Neonatology Program in a Single Healthcare System

Implementation and Outcomes of a Telehealth Neonatology Program in a Single Healthcare System

Pediatric Conditions Requiring Minimal Intervention or Observation After Interfacility Transfer

The fourth industrial revolution and the coronavirus: a new era catalyzed by a virus

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