3-minute case study: Telehealth improves neonatal resuscitation
One out of every 10 newborn babies will need neonatal resuscitation, requiring oxygen at birth, and one out of 100 will need a sophisticated, complex resuscitation. This doesn’t pose an issue for practitioners who do these procedures regularly, but skill deterioration is common for those who don’t. When a hospital or clinic doesn’t have trained staff, transferring the baby to another treatment center quickly (often by helicopter) can cost tens of thousands of dollars.
Intermountain Healthcare, a not-for-profit health system in Salt Lake City, Utah, serves the Intermountain West region — a huge area that includes most of Utah, southern Idaho, and southern Nevada. Intermountain is responsible for almost 50 percent of the healthcare births for Utah; in total, their 40,000 providers include smaller rural practices that might only see 100 births a year.
“In one of our birthing hospitals, we identified, in one year, 16 major errors of resuscitation,” says Stephen Minton, MD, Intermountain’s Chief of Neonatology. It was clear that they urgently needed a program that would train a broader spectrum of providers in neonatal resuscitation, while also keeping costs manageable.
Intermountain implemented a two-part solution that uses technology to offer providers virtual hands-on training. First, they added a video-assisted resuscitation (VAR) program to their telehealth platform; with 270 cameras in over 19 centers, this covered approximately 15,000 births in Utah, in addition to programs in Nevada and Ohio. Minton and other specialists use the cameras to virtually sit at the patient’s bedside alongside the on-site provider, offering guidance as they both observe the patient. Through the VAR program, the team can identify up to 70 percent of the patients who ultimately need resuscitation.
Second, using their virtual platform, Intermountain implemented a rigorous training program emphasizing "one Intermountain neonatal care." It provides detailed education, sets up a team within each hospital responsible for training, conducts trials every month to run through relevant protocol, and documents results for each professional. “I have a document on each hospital that lets me know the last time every nurse and therapist completed training, actually intubated, how to give hand ventilation with a bag and mask, use appropriate oxygen and give appropriate medications,” explains Minton.
The results have been impressive. “It helps with recruitment, it helps with retainment, it helps in outcomes, it reduces cost, and it’s reduced transports,” says Minton. For example, nurses who participated in the Intermountain telehealth training saw their acuity scores jump from 12 to 88 percent.
A Health Affairs study published in December 2018 analyzed the VAR program between 2014 and 2015 in advanced newborn ICUs, and the promising results backed Intermountain’s experience. There were 0.7 fewer transfers per facility per month (over eight a year), and a 29.4 percent reduction in the odds of an infant being transferred. These numbers correspond to 67.2 fewer transfers in total annually and an estimated savings of over $1.2 million—not to mention time saved that can help the newborns, who need assistance quickly to prevent long-term impacts.
However, the difficulties of getting reimbursed for technology-driven solutions is presenting a major obstacle to widespread adoption. Telehealth continues to meet with resistance from insurance companies, who see virtual treatment and training as inferior to in-person care. The situation is improving, and Intermountain has a commitment to stewardship in the community, but they still don’t get full reimbursement for services.
“This is the future of healthcare — the model of how we’re going to communicate to patients and other healthcare professionals,” Milton says. He’s hoping that effective programs like these will prove telehealth’s efficacy — and save more lives in the process.
Katherine Igoe is a frequent contributor to athenahealth's Knowledge Hub.