A 360 Evaluation of Neonatal Care Quality at a Level II Neonatal Intensive Care Unit when Delivered Using a Hybrid Telemedicine Service

Abstract

Objective In 2013, the Section of Neonatal and Perinatal Medicine at the University of Oklahoma's Children's Hospital began providing advanced care to a regional level II neonatal intensive care unit (NICU), using a hybrid telemedicine program. This project compares health care providers' and parents' assessments of health care quality using this program.

Study Design This is a prospective, anonymous, nonrandomized survey of health care providers and parents of neonates using our hybrid telemedicine services. Physicians, neonatal nurse practitioners (NNPs), nurses, and parents completed pencil-and-paper surveys based on their participatory roles. Institutional Review Board approval was obtained at OU Medical Center and Comanche County Memorial Hospital. Surveys consisted of 5-point Likert's scale questions. Descriptive statistics compared the level of agreement with each question across participant groups. A service quality (SQ) composite score was created by summing responses from six SQ questions. Between-group analysis was done on the SQ score using the Mann–Whitney U-test.

Results Nine physicians, 10 NNPs, 12 nurses, and 40 parents completed the survey. Providers agreed (90%) that telemedicine can effectively deliver advanced neonatal care; the care patients receive is comparable to direct patient care (87%); telemedicine enhanced overall patient care quality (90%); providers can effectively interact with each other and families using telemedicine (90.3%), and overall telemedicine experience was good (90%). In total, 61% of providers reported telemedicine improves physician-patient interaction. Parents of newborns agreed that they were well informed about telemedicine use for their child's care (88%), were able to communicate routinely with neonatologists (85%), and were comfortable with their child's physical examinations (93%). Provider's versus family's (SQ) score was not significantly different.

Conclusion All survey participants, including neonatologists, NNPs, nurses, and patient families, reported high levels of satisfaction with the hybrid telemedicine model developed and implemented at this institution which may be comparable to in-person direct patient care.

Key Points

• Implementation of a hybrid telemedicine system provides an alternative to the transfer of newborns needing advanced care to tertiary care facilities.

• In this study, both health care providers and patient family members were satisfied with the quality of care using hybrid telemedicine.

• In this study, families of newborns could fully participate in their child's care using the hybrid telemedicine system.

Keywords

e-Health - telemedicine - teleneonatology - neonatal nurse practitioner - service delivery model - satisfaction survey - advanced neonatal care

Publikationsverlauf

Eingereicht: 11. Februar 2022

Angenommen: 15. August 2022

Accepted Manuscript online:
29. August 2022

Artikel online veröffentlicht:
10. November 2022

• References

• 1 Minton S, Allan M, Valdes W. Teleneonatology: a major tool for the future. Pediatr Ann 2014; 43 (02) e50-e55
• 2 Maddox LJ, Albritton J, Morse J, Latendresse G, Meek P, Minton S. Implementation and outcomes of a telehealth neonatology program in a single healthcare system. Front Pediatr 2021; 9: 648536
• 3 Nadar M, Jouvet P, Tucci M, Toledano B, Sicotte C. Impact of synchronous telemedicine models on clinical outcomes in pediatric acute care settings: a systematic review. Pediatr Crit Care Med 2018; 19 (12) e662-e671
• 4 Sauers-Ford HS, Marcin JP, Underwood MA. et al. The use of telemedicine to address disparities in access to specialist care for neonates. Telemed J E Health 2019; 25 (09) 775-780
• 5 Hoffman AM, Lapcharoensap W, Huynh T, Lund K. Historical perspectives: telemedicine in neonatology. Neoreviews 2019; 20 (03) e113-e123
• 6 Makkar A, Siatkowski RM, Szyld E, Ganguly A, Sekar K. Scope of telemedicine in neonatology. Zhongguo Dang Dai Er Ke Za Zhi 2020; 22 (05) 396-408
• 7 Garingo A, Friedlich P, Chavez T. et al. “Tele-rounding” with a remotely controlled mobile robot in the neonatal intensive care unit. J Telemed Telecare 2016; 22 (02) 132-138
• 8 Makkar A, McCoy M, Hallford G, Escobedo M, Szyld E. A hybrid form of telemedicine: a unique way to extend intensive care service to neonates in medically underserved areas. Telemed J E Health 2018; 24 (09) 717-721
• 9 Makkar A, McCoy M, Hallford G. et al. Evaluation of neonatal services provided in a level II NICU utilizing hybrid telemedicine: a prospective study. Telemed J E Health 2020; 26 (02) 176-183
• 10 Makkar A, Sandhu T, Machut K, Azzuqa A. Utility of telemedicine to extend neonatal intensive care support in the community. Semin Perinatol 2021; 45 (05) 151424
• 11 Garingo A, Friedlich P, Tesoriero L, Patil S, Jackson P, Seri I. The use of mobile robotic telemedicine technology in the neonatal intensive care unit. J Perinatol 2012; 32 (01) 55-63
• 12 McCoy M, Makkar A, Foulks A, Legako E. Establishing level II neonatal services in southwestern Oklahoma. J Okla State Med Assoc 2014; 107 (9-10): 493-496
• 13 Montes MT, Herranz-Rubia N. NeNe Nursing Group. Neonatal nursing in the COVID-19 pandemic: can we improve the future?. J Neonatal Nurs 2020; 26 (05) 247-251
• 14 Lapadula MC, Rolfs S, Szyld EG. et al. Evaluating patients' and neonatologists' satisfaction with the use of telemedicine for neonatology prenatal consultations during the COVID-19 pandemic. Front Pediatr 2021; 9: 642369
• 15 Myers K, Nelson EL, Rabinowitz T. et al. American telemedicine association practice guidelines for telemental health with children and adolescents. Telemed J E Health 2017; 23 (10) 779-804
• 16 Zailani S, Gilani MS, Nikbin D, Iranmanesh M. Determinants of telemedicine acceptance in selected public hospitals in Malaysia: clinical perspective. J Med Syst 2014; 38 (09) 111
• 17 Wernhart A, Gahbauer S, Haluza D. eHealth and telemedicine: practices and beliefs among healthcare professionals and medical students at a medical university. PLoS One 2019; 14 (02) e0213067
• 18 Vinadé Chagas ME, Rodrigues Moleda Constant HM, Cristina Jacovas V. et al. The use of telemedicine in the PICU: a systematic review and meta-analysis. PLoS One 2021; 16 (05) e0252409
• 19 Scholz E, Zuell C. Item non-response in open-ended questions: who does not answer on the meaning of left and right?. Soc Sci Res 2012; 41 (06) 1415-1428