Telemedicine Consultation to Assess Neonatal Encephalopathy in Rural Community Hospitals and Tertiary Care Centers.
Telemedicine Consultation to Assess Neonatal Encephalopathy in Rural Community Hospitals and Tertiary Care Centers.
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DOI：
10.46804/2641-2225.1115
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发表时间：
2022-01
期刊：
影响因子：
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通讯作者：
Rachel Coffey;Misty E. Melendi;Anya K Cutler;A. Craig
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文献类型：
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作者：
Rachel Coffey;Misty E. Melendi;Anya K Cutler;A. Craig
前言远程会诊在三级医院用于评估新生儿脑病。然而，在社区医院出生的新生儿，由于被送到三级护理中心，往往会经历延迟的评估。我们研究了社区医院的远程会诊，以减少这种差异。方法对9所社区医院和1所新生儿重症监护室进行前瞻性观察研究。纳入标准：胎龄大于或等于35周，以下之一：脐带pH值小于或等于7.2，5分钟Apgar值小于7，呼吸支持时间延长，围产期事件，或神经学检查异常。我们进行了同步的、计划外的远程医疗会诊，主要结果是远程会诊的时间。结果从2018年4月至2020年9月，我们进行了53次远程会诊：34次(%)在社区医院，19次(36%)在三级护理中心。社区医院进行远程会诊的中位数为98分钟(IQR，76-127)，而三级护理中心的中位数为68分钟(IQR，43-91)(p=0.004)。在社区医院出生的9名新生儿(26%)仍与父母在一起，没有被转移到三级护理中心进行进一步评估。讨论出生在农村社区医院的新生儿接受远程会诊的时间略晚于出生在三级护理中心的新生儿。远程医疗的使用将这一差距从我们先前研究中的近5小时减少到本研究中的98分钟，因为远程医疗允许在社区医院对新生儿进行评估，而无需将他们转移到三级护理中心。结论远程会诊评估新生儿脑病是将专家级护理引入农村社区医院的一种可行、可及、可靠的方式。
Introduction Teleconsultation is used in tertiary care hospitals to evaluate neonatal encephalopathy. Neonates born in community hospitals, however, often experience delayed evaluation due to transport to the tertiary care center. We studied teleconsultations in community hospitals to decrease this disparity. Methods Prospective observational study in 9 community hospitals and 1 neonatal intensive care unit. Inclusion criteria: gestational age greater than or equal to 35 weeks and one of the following: umbilical cord pH less than or equal to 7.2, 5-minute Apgar less than 7, prolonged respiratory support, perinatal event, or abnormal neurological exam. We performed synchronized, unscheduled telemedicine consults with the main outcome of time to teleconsultation. Results From April 2018 to September 2020, we performed 53 teleconsultations: 34 (64%) in community hospitals and 19 (36%) in the tertiary care center. Teleconsultations occurred at a median of 98 minutes (IQR, 76-127) in community hospitals versus 68 minutes (IQR, 43-91) in the tertiary care center (p = .004). Nine (26%) neonates born in a community hospital remained with their parents and were not transferred to the tertiary care center for further assessment. Discussion Neonates born in rural community hospitals have slightly later teleconsultations than neonates born in the tertiary care center. Telemedicine use reduced this disparity from nearly 5 hours in our prior study to 98 minutes in this study by permitting evaluation of neonates in community hospitals without transporting them to the tertiary care center. Conclusions Teleconsultations to evaluate neonatal encephalopathy are a feasible, accessible, and reliable way to bring expert-level care into rural community hospitals.