O3324: The Effect of Telemedicine on Neonatal Stabilization: A Simulation-Based Pilot Study

Background: Effective pre-transport stabilization is critical to optimize short and long-term outcomes for neonates. Challenges at referring hospitals include prompt and appropriate interventions, access to specialized expertise, and team dynamics. Telemedicine may improve patient outcomes by bridging the gap between the referring and accepting providers’ assessments and plans of care. The primary objective of this study was to evaluate the effect of video telemedicine on time to infant stabilization and efficacy of stabilization as compared to phone consult.

Methods: This is a pre-post, simulation-based pilot study. The study received approval from the Medstar Georgetown University Institutional Review Board (STUDY00006881). Pediatricians working at Level 1 or 2 NICUs, and neonatology fellows were recruited to participate. The pediatricians participated in two distinct neonatal stabilization simulations of equal complexity. In the first simulation, the pediatricians could access a remote neonatology fellow via phone consult (control). In the second scenario, a remote neonatology fellow participated via video telemedicine consult (intervention). Simulations were video recorded and evaluated for adherence to a standardized checklist and for three critical time points: time to intubation, time to consult, and time to stabilization. A convenience sample was used which included recruitment of ten pediatricians and eight neonatology fellows. Descriptive statistics were computed for demographic variables and group characteristics. Mean and median values were computed for the primary and secondary outcome measures and trends assessed. Paired t-tests were used analyze normal continuous data, and Pearson’s Chi Squared or Fischer’s exact tests were used to analyze categorical data.

Results: Recruited fellow participants ranged from PGY4 to PGY6 levels. Pediatrician/Neonatologist experience ranged from 5 to over 20 years of experience and all physicians in both groups were STABLE certified with similar numbers of consults in the past 6 months. There was a decreased mean time to stabilization in the telemedicine consult group as compared to the phone consult group (23.7 vs 16.4 minutes), and improvement in mean simulation scores (87% vs 80%), although these difference were not statistically different. Consultation duration and time to intubation were similar in both the telemedicine and phone consult groups. Confidence scores in neonatal stabilization procedures improved after completion of both of the simulations.

Conclusion: This study supports that telemedicine may decrease the time to neonatal stabilization, a critical determinant of outcomes for transported neonates. Further investigation is warranted to further understand the effects of telemedicine on neonatal stabilization in the clinical setting.