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Legacy Health Tele-Baby Resuscitation
Telemedicine Neonatal Resuscitation:
Partners in Saving Lives – Virtually
Pat Scheans, NNP pscheans@lhs.org
Lauren Rose, MD lrose@lhs.org
Lori Wakashige, MPA: HA lwakashi@lhs.org
TAO 2013
Background Extensive Resuscitation is Rare ~1% of births
(AAP/AHA Neonatal Resuscitation Program-NRP, 2010)
Difficult to Maintain Competence/Confidence (Jukkala and Henly, 2009)
• Community pediatricians rarely lead complex neonatal resuscitations
• Called in emergently- arrive after initial critical care
General Community Pediatrics Focus: Outpatient Medicine
• Neonatal resuscitation/critical care expertise concentrated at centers with NICUs
Past Nursery Team Initiates Resuscitation
• Potentially uneven skill sets/skills levels
Nursery Team Calls Pediatrician/Code Team• Help arrives many minutes into the resuscitation• Members may be unfamiliar with NRP algorithm
Transfer Initiation and Neuroprotective Cooling Delayed Until After Resuscitation• Pediatrician arrives>baby stabilized>calls made
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Present Hub & Spoke Structure
• NNP NRP leader at Randall Children’s Hospital & satellite site NRP team
NNP via Telemedicine Robot • NRP expert leadership within seconds to minutes
Remote Hands-off Leader Improves Care• Whole picture: observes, analyzes, directs (Plaat,
2008)
• Prevents “task-saturation” (Hermansen & Hermansen, 2005)
• Communication and teamwork improve safety (Joint Commission, 2005)
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Future
Remote Leadership
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Benefits
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Faster transport/ Streamlined care to NICU
Task Saturation
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NRP Leader
Teamwork
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RT
Outcomes- 10 Months
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21 Events- Approximately 2% of Deliveries Reasons for Tele-Baby:
>1/3 “crash” c-section or emergency issue>1/2 respiratory distress>non-reassuring heart tones, other
Response Time Within Seconds to Minutes ½ Remained at Level 1 Nursery ½ Transferred to Level 3 NICU
Faster Time to Initiation of Cooling
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Streamlined Care into NICU
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NICU Care
Other Subjective Outcomes
Better Teamwork and Communication
Easily Identifiable Leader
Improved Staff Confidence
Improved Family Satisfaction
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Feedback
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NNP Pediatrician
RN leader
Learning Points Personnel
• Credentialing• Consultation • Billing• Documentation
Equipment • Back up (Robot, NNP computer)
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Hub NNP Team
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Neonatal Nurse Practitioners, Randall Children’s Hospital at Legacy Emanuel
Spoke RN Team
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References American Academy of Pediatrics/American Heart Association. (2010).
Textbook of neonatal resuscitation, 6th ed. Lake Grove Village Il: AAP/AHA.
Hermansen M.C., & Hermansen, M.G. (2005). Pitfalls in neonatal resuscitation. Clinics in Perinatology, 32(1), 77-95. doi: 10.1016/j.clp.2004.10.002
Jukkala, A., & Henly, S. (2009). Provider readiness for neonatal resuscitation in rural hospitals. Journal of Obstetric, Gynecologic and Neonatal Nursing, 38, 443-452. doi: 10.1111/j.1552-6909.2009.01037.x
Plaat, F. (2008). Neonatal resuscitation – the team needs a leader. Clinical Risk,14, 43–45. doi: 10.1258/cr.2008.080014.
Yates, G., Bernd, D., Sayles, S., Stockmeier, C., Burke, G., & Merti, G. (2005). Building and sustaining a system wide culture of safety. Joint Commission Journal on Quality and Patient Safety, 31(12), 684-689. Retrieved from http://www.ingentaconnect.com/content/jcaho/jcjqs/2005/00000031/00000012/art00005
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