Mayo Clinic says neonatology telehealth saves infants' lives, avoids transfers
As a center of excellence in neonatology, the Mayo Clinic is using telemedicine to provide remote consultations throughout the region for high-acuity neonatology needs, such as resuscitation assistance. Mayo’s program has been successful in providing coverage to areas that previously would not have direct access to specialists and enabling those locations to reduce the need to transfer patients.
“Our tele-neonatology program focuses on assisting local care teams during high-risk newborn resuscitations that occur in the community setting,” said Jennifer Fang, MD, who works in Mayo’s tele-neonatology and resuscitation program. “This most commonly includes pre-term infants, newborns with respiratory distress, or babies who require advanced resuscitation.”
With video telemedicine, the Mayo Clinic’s neonatologists can be virtually present at the bedside to assess the newborn and work closely with the care team during a resuscitation. The neonatologist in the hub site can help guide the critical steps of newborn resuscitation, such as airway management, effective ventilation and other procedures such as central line placement.
“About 10 percent of babies will need some assistance to begin breathing after delivery, and 1 in 1,000 will need extensive resuscitation,” Fang said. “So in many community hospitals, these high-risk situations may only occur a few times each year. Based on the literature, we know that newborns who require advanced resuscitation, especially very premature infants, have poorer outcomes when delivered at hospitals with lower levels of neonatal care.”
With telemedicine, the Mayo Clinic has the opportunity to bring additional neonatology experience to the bedside of these critically ill babies when they need it most. The remote neonatologist can assist the community physician to ensure the highest level of care is being provided to every newborn regardless of birth location.
“In fact, in the Mayo Midwest region, less than half of newborns had access to a neonatologist before we had our tele-neonatology program,” said Fang of Mayo’s telemedicine program, which uses telehealth technology from InTouch Health. “As of October 2016, we can now say that 100% of babies born in the Mayo Midwest region have access to neonatal expertise should they need it. That’s a pretty amazing achievement in healthcare delivery for the newborn population.”
There are many different situations that have arisen during tele-neonatology sessions. Fang walked through one.
“We had a pregnant woman present to a community hospital with placental abruption, which is a life-threatening event for both mother and baby,” she said. “The baby was delivered via an emergency Cesarean-section, and he immediately needed advanced resuscitation including cardiopulmonary resuscitation, CPR.”
Via telemedicine, the Mayo neonatologist was able to work with the local care team to bring the baby’s heart rate up into the normal range and achieve normal blood oxygen levels. Because of the events surrounding delivery, the neonatologist also instructed the team to start passive hypothermia, which allows the baby’s temperature to drop below normal to protect against brain injury.
“Telemedicine allowed the neonatologist to optimize care for this baby who was at risk of dying or experiencing serious complications, but instead he went home healthy with his parents after a brief stay in the NICU,” Fang explained. “In these cases, everyone involved feels the positive impact of tele-neonatology – the local physicians and nurses, the consulting neonatologist, and, most important, the patient and family.”
Because of strong collaboration between the Mayo Clinic’s Division of Neonatal Medicine, its Center for Connected Care and its colleagues in the Mayo Clinic Health System, the tele-neonatology program has been very successful on many fronts, Fang said.
“We have provided more than 200 tele-neonatology consults since the program began four years ago,” she said. “After a telemedicine consult, approximately one-third of the babies are able to remain in the community hospital – thus avoiding unnecessary patient transfers and keeping babies safely with their families.”
In addition, telemedicine has had a positive impact on patient referrals, Fang said.
“After implementing telemedicine services, we have seen a nice upward trend in the number of patients we admit from participating hospitals,” she added.
The Mayo Clinic also has found that local physicians are very satisfied with the tele-neonatology service. 96 percent of providers agree that the tele-neonatology consult improved patient safety and/or quality of care, and 98 percent would use tele-neonatology again and would recommend its use to their colleagues, according to a Mayo Clinic study.
“Most important, we just completed a retrospective cohort study that demonstrates tele-neonatology significantly improves the quality of high-risk newborn resuscitations that occur in community hospitals,” Fang said. “When experts rated the quality of resuscitation on a scale of 1 (poor) to 10 (excellent), the average rating for babies who received a tele-neonatology consult was 7 compared to 4 for similar babies who did not receive a consult.”
Similarly, 55 percent of babies who received a telemedicine consult earned a quality rating of 5 or higher compared with 30 percent of babies who did not receive a consult, according to the study.
“We hope this is the first of many studies,” Fang said, “that look at the value telemedicine can bring to neonatal medicine.”