Background: Telemedicine, specifically videoconferencing, has been used in neonatology to bridge disparities of experience between institutions but it has not yet been established to replace telephone guidance for infant resuscitations between neonatal intensive care units (NICUs).
Objective: To assess opinions of NICU providers regarding use of telemedicine to guide neonatal transport resuscitations in comparison to current standard practice without telemedicine; and assess the accuracy of obtaining clinical and radiological data via the telemedicine platform.
Design/Methods: We conducted a pre- and post-survey of twenty NICU providers at the University of Massachusetts Memorial Medical Center (UMMMC) after obtaining a new telemedicine system that allows videoconferencing between UMMMC and affiliate NICUs. The pre-survey included 21 questions regarding comfort with telemedicine. Each provider then completed an identical simulation scenario using the new system. The provider utilized Neonatal Resuscitation Program algorithms to help guide a bedside provider through the simulated resuscitation. During each simulation, a bedside provider performed scripted errors and a consistent abnormal x-ray finding was displayed to assess whether providers were able to accurately identify the abnormalities via video. After the simulation a survey which had the same questions as the pre-survey in addition to questions regarding ability to assess findings was completed. The two-surveys were compared using a pre- and post-test design with use of factor analysis to assess providers opinions and accuracy of a telemedicine platform.
Results: The use of telemedicine during simulated transport resuscitations led to significant improvement in providers' opinions regarding the use and accuracy of the telemedicine platform. At item-level, 8 out of 15 items showed statistically significant improvement (p<0.05). Three composite scales, representing providers' opinions about the benefit to patients, ease and confidence of use, and accuracy of the platform, were identified from factor analysis and validated psychometrically. They explained 76% of the total variance, with Cronbach alpha ranging from 0.70 to 0.94. All three scales showed significant improvements in using the system (p<0.05, Figure 1).
Conclusion: The use of telemedicine as compared to the current standard of care was perceived by NICU providers as a safe and accurate way of obtaining as well as managing clinical data for simulated neonatal transport resuscitations.
