Award Candidate Poster Presentation
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.
Rajavee Panchal, MD
Yale School of Medicine Department of Pediatric Emergency Medicine
Visiting Medical Student
Yale School of Medicine Department of Emergency Medicine
Christie Bruno, DO
Assistant Professor of Pediatrics (Neonatology)
Yale University School of Medicine Department of Pediatrics
New Haven, CT
Ambrose H Wong, MD, MSEd
Instructor in Emergency Medicine; Director of Simulation Research
Yale University School of Medicine Department of Emergency Medicine
Catherine Allan, MD
Associate Program Director - Simulator Program
Boston Children's Hospital