Expanding the Circle of Influence With Neonatal Telehealth

If there is one area of Neonatology that is experiencing rapid growth it would be in telemedicine.  Each month I come across new reports of centers utilizing this strategy whether to connect families and their infants (televisitation) when they cannot be present or to connect medical teams with other centres lacking the local expertise to care for newborns with certain conditions.

I am fortunate to work in a centre that has an established telehealth program. The city of Winnipeg in Manitoba, Canada covers a exceptionally large geographic area.  On average we transport between 280 – 300 patients per year from as far as the Arctic Circle to North Western Ontario.    To put this in perspective, I had the pleasure of presenting our work at a conference in Ireland in 2013.Untitled  Superimposing the country of Ireland over a map of our catchment area provides some perspective of distances I am talking about.

The topic in this case was the impact of using Telehealth to reduce Neonatal transports by supporting care providers in families in their home cities and towns.  As care providers, if we have a strategy that can in some cases keep babies together with their families and support networks in their own communities, how can we not explore that possibility?  We commonly talk about the importance of family centred care and if you ask me it should begin with doing what is best for the family unit which is minimize the trauma to the family unit after delivery.  I thought it was worth sharing as it gives the people of Manitoba and beyond an idea of how dramatic an impact Telehealth can have when used in a clinical manner.  Telehealth of course is valuable for televisitation and allowing remote meetings but there is so much more. To our knowledge this is the first such use of telehealth in Canada and was awarded a leading practice designation by Accreditation Canada in 2013.  The effectiveness of this strategy has paid for the cost of implementation many times over and I would strongly urge other centres to explore with their Telehealth services whether it would be right for their centre.

How effective was the strategy?  In the year following May 2012 implementation an estimated 4 air and 12 ground transports were averted. Using an average cost of $10000 per air and $5000 per ground transport it is estimated that the total health care savings is $100000.

The Leading Practice can be found using this link which describes in detail what we accomplished and how it benefited the people of Manitoba.

Dare to Dream

The use of telehealth need not stop at the assistance of other care providers in caring for sick neonates.  As the field is developing I see the a larger benefit to long distance education.  How many non-tertiary care centres would benefit from linking to centres with more expertise in the neonatal field and being walked through new procedures or equipment that they are unfamiliar with.  The time and cost to travel to these remote locations can be avoided by the use of a high definition camera and regular scheduling of sessions.  If we want the best for the babies in our catchment areas, education can not be limited to the walls of the hospital we work in.  Prevention of adverse outcomes must start with providing proper care to the newborns in the place of birth rather than having the transport team address the issues that have already arisen.

As the technology becomes more available and at a lower cost I have no doubt we will see expansion of services.  Retcams exist already which are capable of avoiding transfer of discharged infants back for ROP screening.  Retcam__2This in fact has been recently reviewed by Fierson et al in January of this past year.  Alternatively, breastfeeding support is possible by connecting those with expertise in lactation support to rural centres without such training.  Why should breastfeeding success rates in rural communities be any different than in urban centres when the education can be brought to them?  Such an opportunity was highlighted recently by Friesen et al in 2015.

Are there other telehealth modalities that you know of out there that could help improve the care we provide to these vulnerable infants? The field of telehealth is exploding and with it opportunities to improve our care and ideally outcomes.  I encourage everyone whenever possible to ask the question “Can we link up so we can see a patient?”.  All too often what has been described and what is actually present in terms of signs and symptoms may be quite different.

To see the presentation click on the link below

Ireland

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