Legacy Health Tele-Baby Resuscitation Telemedicine Neonatal Resuscitation: Partners in Saving Lives – Virtually Pat Scheans, NNP [email protected] Lauren.

Legacy Health Tele-Baby Resuscitation

Telemedicine Neonatal Resuscitation:

Partners in Saving Lives – Virtually

Pat Scheans, NNP [email protected]

Lauren Rose, MD [email protected]

Lori Wakashige, MPA: HA [email protected]

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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