1. HYBRID FORM OF TELEMEDICINE: A UNIQUE WAY TO PROVIDE SERVICE IN LEVEL II NICUS Abhishek Makkar, MD, Mike McCoy, CRNP, Gene Hallford, PhD and Edgardo Szyld, MD Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center; Oklahoma City, Oklahoma, USA
RESULTS I
RESULTS II
BACKGROUND
The use of telemedicine as a primary means of patient contact and management is understudied in the neonatal population.
Hybrid telemedicine system consisting of 24/7 NNP staffing with a neonatologist physically present 3 days a week and using a high definition camera the remaining 4 days for examination and communication with staff and parents was recently implemented at Comanche County Memorial Hospital (CCMH) to manage infants in Level II NICU.
Eighty seven neonates at CCMH and 56 neonates at OUMC were included in the analysis. Comparison was done by stratifying gestational age in 4 groups. (Table)
Compared to OUMC, neonates at CCMH had significantly shorter hospital stay (Figure 1), reached full enteral feeds sooner (Figure 2), had fewer total days of supplemental oxygen (Figure 3), and fewer days on non invasive ventilation support. (Figure 4)
Figure 3- Use of supplemental Oxygen *
N=9
N=14
N=24
N=17
N=44
N=18
N=10
N=7
Table
Gestational Age
CCMH
OUMC
32 weeks
9 (10.3%)
14 (25%)
33 weeks
24 (27.5%)
17 (30.35%)
34 weeks
44 (50.57%)
18 (32.14%)
35 weeks
10 ((11.49%)
7 (12.5%)
Total 87 56
OBJECTIVE
Figure 4- Non invasive ventilation support
To evaluate the safety and efficacy of treatment of premature infants managed by hybrid telemedicine system in Level II NICU compared to conventional management provided to similar population in a large referral Level IV NICU at OU Medical Center (OUMC). *
89%
Figure 1- Length of stay
N=9
N=14
N=24
N=17
N=44
N=18
N=10
N=7
METHODS
Retrospective non-inferiority study comparing outcomes of premature infants admitted either to the CCMH or OUMC.
All weeks GA infants admitted at CCMH between July 2013 to June 2015 were included. Infants between weeks GA who were transported to OUMC from areas geographically comparable to CCMH were included for comparison.
Infants requiring mechanical ventilation > 24 hours or advanced subspecialty services were excluded.
Registered variables were: length of stay, type and duration of respiratory support, length of antibiotic therapy, and time to full enteral feedings. Between group comparisons were performed using statistical tests appropriate for the type of data analyzed, with the SAS Statistical Software (V9.3).
CONCLUSIONS
N=9
N=14
N=24
N=17
N=44
N=18
N=10
N=7
Hybrid Telemedicine system is a safe and cost-effective strategy that may be used in extending intensive care to neonates in medically underserved areas.
Figure 2- Time to full feeds * *
N=9
N=14
N=24
N=17
N=44
N=18
N=10
N=7