Clinical Services

Oral Presentation

(CS2-02) A Mixed Methods Study on the Barriers and Facilitators of Telemedicine for Newborn Resuscitation

Sunday, April 23
12:00 PM - 12:30 PM
Location: W224 AB

Objectives
1. Understand provider perceptions and use of telemedicine for newborn resuscitation (termed teleneonatology).
2. Identify potential barriers to implementation and use of teleneonatology services.
3. Recognize local initiatives that optimize inclusion of teleneonatology into the local practice.

Methods
In March 2013, Mayo Clinic’s Division of Neonatal Medicine began offering telemedicine consults to support local providers during high-risk newborn resuscitations. From 10/2015 to 06/2016, we conducted a mixed methods study to understand facilitators and barriers to the use of teleneonatology services.

In October 2015, electronic surveys were sent to 349 physicians and nurses at six health system sites that received teleneonatology services. The survey remained open for three months, and two reminder emails were sent to non-respondents at two week intervals. The survey assessed frequency of telemedicine use, reasons for non-use, user satisfaction, and perceived value.

Following the survey, focus groups (9) and individual semi-structured interviews (4) were conducted with provider volunteers between 12/2015 and 06/2016. These methods were used to gain an in-depth understanding of acceptability and utilization of teleneonatology services, the importance of telemedicine in newborn resuscitation, barriers that may impact service use, and practice improvement suggestions.

Results
The survey response rate was 31.8% (n=111 respondents). Fifty percent of respondents (n=56 of 111) had used the teleneonatology service. Of the non-users (n=55), 65% didn’t use the service because they did not have a clinical need (n=36). However, 44.4% of users (n=24 of 54) thought there were times when teleneonatology could have been used but was not. Ninety percent of teleneonatology users (n=49 of 54) were satisfied with the experience; 96% (n=50 of 52) felt the consult was helpful.

Eighteen physicians and 31 nurses participated in focus groups/ interviews. Barriers to the use of teleneonatology included differences in expectations for activation, variable interactions with the neonatologist, additional time and staffing needed for use, and fears around incompetency. To optimize inclusion of teleneonatology into local practices, participants suggested providing frequent staff training, continuously reassuring providers that competencies are not being assessed, and selecting technology that is very simple to use.

Conclusion
Our teleneonatology program has a high level of user satisfaction and is viewed as an important, helpful service by local care teams. There are inconsistencies regarding if and when to activate the service. This may be due to multiple factors including changes to local workflows that require extra time and staff, usability of the technology, and provider concerns about being perceived as incompetent. Health systems establishing teleneonatology programs should strive to select a technology that is reliable and easy-to-use, provide frequent training to both local care teams and consulting neonatologists to ensure an effective telemedicine interaction, and create a culture of safety that is encouraging to all providers.

Jennifer Fang

Clinical Service Program Manager for Teleneonatology
Mayo Clinic, Division of Neonatal Medicine

Dr. Jennifer Fang attended Mayo Medical School and completed her pediatric residency at Lucile Packard Children’s Hospital at Stanford University. She practiced as a neonatal hospitalist in California and Minnesota for nine years. Dr. Fang holds a Master’s degree in the Science of Health Care Delivery from Arizona State University and is an Assistant Professor of Pediatrics at Mayo Clinic. She is currently a third year fellow in Neonatal-Perinatal Medicine at Mayo Clinic and will join the faculty in July 2017. Dr. Fang’s academic interests include improvement science and innovative approaches to health care delivery. She has served as the Clinical Service Program Manager for teleneonatology since it began in March 2013. This program uses emergency synchronous video telemedicine to support local providers during high-risk newborn resuscitations. It has been used in over 130 cases, ranging from resuscitation of extremely premature infants to management of unanticipated congenital anomalies.

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Katherine Carroll

Research Fellow
Australian National University

Katherine Carroll is a PhD in medical sociology. She conducts qualitative research into the delivery and experience of perinatal and reproductive medicine.

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Christopher Colby

Chair, Division of Neonatal Medicine
Mayo Clinic, Division of Neonatal Medicine

Dr. Christopher Colby attended the Medical College of Wisconsin and completed his pediatric residency and neonatal-perinatal fellowship at Lucile Packard Children's Hospital at Stanford University. After completing fellowship, Dr. Colby joined the Division of Neonatal Medicine at Mayo Clinic, where he has served as division chair for the last 4 years. He was a member of the AAP's Neonatal Resuscitation Program steering committee from 2009 to 2015 and continues to serve as a reviewer for the International Liaison Committee on Resuscitation. Dr. Colby has been the physician champion for Mayo Clinic's teleneonatology program since its inception in March 2013. He is the Medical Director of Pediatric Telehealth for the Children's Center and is a member of the Connected Care Emergency Telemedicine Convergence Steering Committee.

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Gladys Asiedu

Assistant Professor of Health Services Research
Mayo Clinic

Education and Degree: B.A Hons (English and Religious studies), M.S Family Studies, Graduate Certificate in Women's Studies, PhD in Human Ecology.
I have an extensive experience in qualitative research methods and analysis. I have conducted data analysis using qualitative methods on several projects in the area of health care and service delivery including stakeholders’ perspectives on a sustainable model of care coordination for complex patients, patients’ decision making around clinical trial participation. Quite recently I led a team of investigators at Mayo Clinic to identify best practices in using the Jackson TableTM for prone patient positioning during spine surgery. The research identified several important practice opportunities for improving provider and patient safety in spine surgery. As a result practice changes have occurred including a standardized practice for transfer of patients, educational tools, checklists for thorough equipment check during patient transfer and positioning. This intervention was not previously identified in literature or through benchmarking. I am currently involved with a study utilizing photo elicitation to understand patient and family caregiver experiences with home enteral nutrition (HEN), determining whether current education material and pre-tube placement preparation program is adequate to instruct patients and caregivers provision of enteral nutrition at home and assess any contributing factors towards complications with the process of tube feeding. Preliminary findings of the study have enabled significant change to the Mayo Clinic HEN program's pre-placement education to better prepare patients and their families for enteral feeding at home.
My experiences in applying qualitative methods in health service research has focus on discovering and understanding specific health concerns and service needs related to patients and families, health care providers and the community as interactive partners in a framework that enable multilevel analyses and understanding. I have been engaged in academic presentations and teaching qualitative methods. I have also presented several workshops and conference presentations on the topics of research that I am involved with.

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Ann M. Harris

Associate DIrector Mayo Clinic Survey Research Center
Mayo Clinic

Associate Director Mayo Clinic Survey Research Center. Publications: James Katherine M., Ziegenfuss Jeanette Y., Tilburt Jon C., Harris Ann M, Beebe Timothy J. "Getting Physicians to Respond: The Impact of Incentive Type and Timing on Physician Survey Response Rates." Health Services Research 46 ( 1p1) 232-242. Ziegenfuss,Jeanette Y., Kelly R. Burmeister, Ann Harris, Stefan D. Holubar, and Timothy J. Beebe. "Telephone follow-up to a mail survey: when to offer and interview compared to a reminder call." BMC medical research methodology 12,no. 1 (2012): 32.

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