Mayo’s teleneonatology program: How rapid intervention saves babies’ lives

At the recent Telehealth Innovation Forum in Santa Barbara, California, Doctors Christopher Colby and Jennifer Fang from Mayo Clinic documented how teleneonatology can provide the same extraordinary benefits as telestroke programs.

“High-risk births and strokes share many characteristics,” says Colby. “Both are episodic and highly time-sensitive. Although the majority of neonatology specialists are in large metropolitan areas, a mother can present to any hospital. Transport from a community hospital to a Level IV NICU can be time-consuming and challenging, especially in areas like Minnesota and Wisconsin that experience brutal winters.”

Between 30% and 40% of all deliveries take place in community hospitals. Since only about one in 1,000 births requires neonatal resuscitation, a community hospital may have only one such occurrence every two to three years. Consequently, providers in many smaller hospitals find the technical skills required for advanced resuscitation to be challenging, including advanced airway management, chest compressions and weight-specific medication dosing for patients who weigh less than a pound. Many of these providers aren’t frequently exposed to deliveries that require them to perform every step in the Neonatal Resuscitation Program (NRP) protocol, a standard of care which includes a minute-by-minute algorithm of steps to take.

Many of these high-risk babies arrive as early as the 23rd week of pregnancy and weigh less than one pound at birth. The current infant mortality rate is about 5 to 6 per 1,000 live births. Many of the clinical situations that lead to mortality in the newborn period, such as prematurity, acute blood loss, and hypovolemic shock, are commonly encountered by a neonatologist. Perhaps that number could be reduced if the newborn is seen by a specialist who knows how to urgent treat these conditions. “It’s especially critical to monitor the baby’s temperature, blood glucose and blood gas in these early minutes,” adds Colby.

To improve neonatal care and mitigate some of these risks, Mayo Clinic launched its pilot teleneonatology program in 2013. Since then, Mayo specialists have conducted more than 200 teleconsults. The program connects neonatologists in Rochester with providers at 10 spoke hospitals (seven of which have only a Level I nursery).

Success across the Board

By any metric, the Mayo teleneonatology program has produced impressive results:

• Reduced the time to effective ventilation by 35% -- from 4.2 minutes to 2.7 minutes during simulated newborn resuscitations

• Achieved 100% compliance with NRP protocol. Providers were able to successfully perform all five corrective steps for ineffective ventilation. NRP compliance is a key factor in defending against malpractice suits.

• 100% of patients in the Mayo service area now have access to neonatology expertise compared to just 43% prior to the program.

• 33% of the babies are able to remain in their community hospitals.

• 96% of the providers who have participated feel that remote consultations improve patient safety and quality of care.

“More than 5,500 babies are born each year at our spoke hospitals,” says Dr. Fang. “By bringing neonatal expertise to these hospitals, far fewer babies need to be transported to our Rochester NICU.”

Mayo Clinic has produced a simulation video that shows exactly what happens when a specialist in Rochester remotely oversees a care team in those first critical minutes. What they do in those few minutes can add many decades to a patient’s life.

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