Mayo Clinic telemedicine for high-risk births improves patient safety at community hospitals

Expert telemedicine consultation during high-risk newborn deliveries can improve patient safety in hospitals less familiar with advanced newborn resuscitation, according to a new study published in Mayo Clinic Proceedings.

Approximately one in 10 newborns need assistance breathing after birth and one in 1,000 need intensive resuscitation. For community hospitals less familiar with such interventions, these high-risk deliveries may prove problematic.

To determine the potential efficacy of telemedicine newborn consultations in improving outcomes, Mayo Clinic's Division of Neonatal Medicine in Rochester, Minn., provided six health system sites with a total of 84 consultations for high-risk deliveries over a span of 20 months. Reasons for consultation included infant prematurity, respiratory distress and advanced resuscitation. After the consult, one-third of the infants were able to remain in the local hospital instead of being transferred to a larger hospital outside of the community.

"The enhanced access to neonatologists, who could remotely assess the newborn and guide the local care team through the resuscitation, allowed one-third of the babies to stay with their families in the local hospital," said Jennifer Fang, MD, a Mayo Clinic fellow in Neonatal-Perinatal Medicine and one of the study's authors. "This allowed the patients to receive the correct level of care in the right location — increasing the value of care. Also, the potential cost savings can be substantial."

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Despite these favorable outcomes, sixty-four surveys filled out by physicians at the community hospitals revealed a substantial amount of dissatisfaction with the technology used to conduct the consultations. Physicians reported poor or unusable audio or video quality in 25 percent and 18.8 percent of the cases, respectively. Additionally, a video connection could not be established 9.5 percent of the time. Even with these technical issues, 93.3 percent of community physicians who responded to a survey question on safety agreed the telemedicine consult improved patient safety, quality of care or both.

The study's authors concluded, "Telemedicine consultation for neonatal resuscitation improves patient access to neonatology expertise and prevents unnecessary transfers to a higher level of care. A highly reliable technology infrastructure that provides high-quality audio and video should be considered for any emergency telemedicine service."

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