1. Legacy Health Tele-Baby Resuscitation
TAO 2013
Telemedicine Neonatal Resuscitation:
Partners in Saving Lives – Virtually
Pat Scheans, NNP
Lauren Rose, MD
Lori Wakashige, MPA: HA
Legacy Health Tele-Baby Resuscitation

2. 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

3. 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
4/23/2017
LEGACY HEALTH

4. Present Hub & Spoke Structure NNP via Telemedicine Robot
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)
4/23/2017
LEGACY HEALTH

5. Future

6. Remote Leadership
4/23/2017
LEGACY HEALTH

7. Benefits Experienced leader Enhanced communication and teamwork
Improved NRP algorithm adherence
Faster transport/ Streamlined care to NICU
4/23/2017
LEGACY HEALTH

8. Task Saturation Perform Procedures Lead Team NRP Leader Drug Dosing
Compressions
Ventilations
Drug Dosing
IV Access
Intubation
NRP Leader
April 23, 2017
LEGACY HEALTH

9. Teamwork
NNP RN
Ped RT
4/23/2017
LEGACY HEALTH

10. Outcomes- 10 Months 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
4/23/2017
LEGACY HEALTH

11. Faster Time to Initiation of Cooling
Decreased Time to Turning Warmer Off
Increased Speed of Identifying Cooling Need
4/23/2017
LEGACY HEALTH

12. Streamlined Care into NICU
Audio-Visual Assessment
Connect with NICU via Tele-Baby
Transport Team Dispatch
NICU Care
4/23/2017
LEGACY HEALTH

13. Other Subjective Outcomes
Better Teamwork and Communication
Easily Identifiable Leader
Improved Staff Confidence
Improved Family Satisfaction
4/23/2017
LEGACY HEALTH

14. Feedback Tele-Baby RN leader “I felt calmer as soon as she beamed in”
“The continuity of care is wonderful”
“I felt calmer as soon as she beamed in”
“I don’t ever want to be without it”
NNP
Pediatrician
4/23/2017
LEGACY HEALTH

15. Learning Points Personnel Equipment Credentialing Consultation Billing
Documentation
Equipment
Back up (Robot, NNP computer)
4/23/2017
LEGACY HEALTH

16. Hub NNP Team
Neonatal Nurse Practitioners, Randall Children’s Hospital at Legacy Emanuel
4/23/2017
LEGACY HEALTH

17. Spoke RN Team
4/23/2017
LEGACY HEALTH

18. 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), doi: /j.clp
Jukkala, A., & Henly, S. (2009). Provider readiness for neonatal resuscitation in rural hospitals. Journal of Obstetric, Gynecologic and Neonatal Nursing, 38, doi: /j x
Plaat, F. (2008). Neonatal resuscitation – the team needs a leader. Clinical Risk,14, 43–45. doi: /cr
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), Retrieved from
4/23/2017
LEGACY HEALTH