Award Candidate Poster Presentation

Poster

The Impact of Telemedicine on Neonatal Resuscitation in the Emergency Department: A Simulation-Based Trial

Tuesday, May 15
09:45 - 10:45
Location: Saturn 1&2

Background: : More than 90% of Emergency Departments lack access to a pediatric or neonatal specialist. A significant percentage of neonates will require some degree of resuscitation at birth; this risk may be increased in precipitous or non-delivery room births. Delivery and initial resuscitation of an infant is a required, but rarely practiced skill in Emergency Medicine. In the absence of an in-person specialist, telemedicine can be used to provide real-time, remote access to neonatal sub-specialists. Previous studies using telemedicine for neonatal resuscitation have shown decreased time to adequate ventilation, increased access to specialists, decreased unnecessary transfers, and decreased costs.

Research Question: : Our aim is to determine the impact of telemedicine on the quality of neonatal resuscitation. We hypothesize that access to a Neonatal Resuscitation Program (NRP)-trained pediatric specialist via telemedicine will improve adherence to four critical actions reflecting NRP guidelines in a simulated neonatal resuscitation .

Methodology: : Twelve senior Emergency Medicine residents were randomized into a telemedicine (intervention) or standard care (control) group in a Yale IRB-exempt study. Each was presented with a standardized, simulated, apneic and bradycardic neonate requiring resuscitation using a Laderal SimNewB mannequin. The scenario was scripted with a scripted confederate nurse present in the room. Vital signs were displayed in real time. Each participant had access to a standardized, limited supply of resuscitation equipment, an NRP cognitive aid, and an infant warmer. In the telemedicine group, a pediatric specialist took over leadership, while in the control group, subjects continued to lead the resuscitation without additional telemedicine support. Adherence to NRP guidelines was evaluated using four critical actions reflecting the guidelines' focus on simple, high-yield interventions and optimization of ventilation. The four critical actions included: basic warming and stimulation, initial use of 21% oxygen, positive pressure ventilation attempted prior to intubation, and intubation prior to initiation of chest compressions. Data was collected via video (B-Line SimCapture) and assessed by three trained physician reviewers.

Results: : The intervention groups adherence to the four critical NRP actions was better than the control group in three of the four items (Table 1). No members of the control group completely optimized ventilation with both appropriate oxygen supplementation and positive pressure ventilation prior to starting chest compressions.

Discussion/Conclusions: : The use of telemedicine was associated with improved adherence to critical actions reflecting NRP guidelines in our simulated neonatal critical care study. We plan to refine these methods and evaluation criteria for planned research studying both advance practice providers and attending physicians working in the Emergency Department. This study illustrates the ability of telemedicine to provide substantial decision-making support and real-time access to a specialist in high-risk, low-frequency events. Given the potential to improve patient care for a vulnerable population, future studies should evaluate the impact and acceptability of this intervention in clinical practice.





Isabel T. Gross, MD PhD MPH

Pediatric Emergency Medicine Fellow
Yale University School of Medicine
New Haven, CT

Dr. Gross was born and raised in Germany. She earned her MD and PhD at the Albert-Ludwigs University Freiburg, Germany. Thereafter, she started her pediatric residency in Germany and then moved to the United States to complete a pediatric residency and chief residency at the University of South Florida. During residency, she completed an MPH with a concentration on Disaster Management and Humanitarian Relief at the University of South Florida, Tampa. Dr. Gross is currently a pediatric emergency medicine fellow at Yale University School of Medicine. She is the Chair of the Scientific Review Committee of the INSPIRE pediatric research network as well as the Trainee Liaison of the Emergency Medicine Section, Society of Simulation in Healthcare. She has been active in simulation education and research for five years with a focus on community outreach simulations, tele-simulations, and international simulations.

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Katherine Couturier, MD, MPH

Resident Physician
Yale-New Haven Emergency Medicine

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Rajavee Panchal, MD

Researcher
Yale School of Medicine Department of Pediatric Emergency Medicine

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John Parker

Visiting Medical Student
Yale School of Medicine Department of Emergency Medicine

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Travis Whitfill, MPH

Research Scientist
Yale University School of Medicine, CT

Travis Whitfill is an Associate Research Scientist in the Department of Pediatrics. His background began in molecular biology and biochemistry, after receiving scientific training at the MD Anderson Cancer Center and Duke University. He is the co-founder of several additional startup companies, including a Connecticut-based microbiome company, Azitra Inc. He brings strong background in entrepreneurship and business, and is also a partner in a venture capital fund, Bios Partners, bringing experience in public markets, drug development, and venture capital investments.

His research interests are in pediatric emergency medicine and health policy and to improve pediatric acute care across the United States.

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Christie Bruno, DO

Assistant Professor of Pediatrics (Neonatology)
Yale University School of Medicine Department of Pediatrics
New Haven, CT

Dr. Christie Bruno is currently an Assistant Professor of Pediatrics and Attending Neonatologist at Yale School of Medicine and Yale-New Haven Children's Hospital. Dr. Bruno completed her pediatric residency training at Thomas Jefferson University/duPont Hospital for Children and her neonatal-perinatal medicine training at the Children's Hospital of Philadelphia. Her interests include medical education, neonatal neurodevelopmental outcomes, and neonatal simulation training.

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Ambrose H Wong, MD, MSEd

Instructor in Emergency Medicine; Director of Simulation Research
Yale University School of Medicine Department of Emergency Medicine

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Catherine Allan, MD

Associate Program Director - Simulator Program
Boston Children's Hospital
Boston, Massachusetts

Catherine Allan, MD is the Associate Program Director of the Simulator Program and Medical Director of the Cardiac Intensive Care Unit at Boston Children’s Hospital. Over the last 10 years she has helped to develop a robust, interdisciplinary program in ECMO Simulation at Boston Children’s Hospital. Dr. Allan has translated this model to other insitutions on both a National and International level to help these programs build new clinical ECMO Programs. She has published on the use of ECMO Simulation Skills Training and on clinical outcomes following ECMO support in the congenital heart disease population and has presented on ECMO simulation at multiple National and International Meetings.

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