How a Telehealth Partnership is Expanding Critical Care for Newborns

March 16, 2023 - Amid a maternal and infant care crisis brewing in rural America, some hospitals are banding together to ensure vital access to care is not disrupted. One of the key tools being used to enhance care access is telehealth.

More than half of rural counties have no hospital-based obstetrical services, resulting in more than 50 percent of rural women traveling more than 30 minutes to the nearest facility offering these services, according to a report by the Commonwealth Fund in 2021.

A study published in 2022 in Clinical Obstetrics and Gynecology notes that the lack of maternal healthcare access in rural areas can result in "several adverse maternal and infant outcomes including premature birth, low birth weight, out of hospital births, maternal and infant morbidity and mortality, and increased risk of postpartum depression."

Further, given the increased risk of adverse neonatal outcomes in rural areas, there are alarmingly few neonatal intensive care beds in community hospitals nationwide. Recent data published by the American Hospital Association shows that out of 789,354 staffed beds in community hospitals, only 23,096 are neonatal intensive care beds.

To address the lack of neonatal intensive care access and provide higher-acuity care for newborns, San Juan Regional Medical Center in Farmington, New Mexico, struck a telehealth partnership with Presbyterian Hospital's neonatal intensive care unit (NICU) team. According to leaders from both organizations, the partnership has bolstered neonatal care in Farmington.

THE TELEHEALTH PARTNERSHIP

An informal partnership between San Juan Regional Medical Center and Presbyterian Hospital has been ongoing for years, with San Juan Regional clinicians often calling Presbyterian specialists over the phone to discuss patient care, said Brad Scoggins, DO, pediatrician and medical director at San Juan Regional.

The Centers for Disease Control and Prevention pushed the partnership into a more formal, video-based arrangement.

"They came to us and said, 'Hey, in order for you guys to continue to provide level two NICU care or nursery care, we need you to partner with a NICU,'" Scoggins said in a phone interview. "My first phone call was to our former colleague in Farmington, Dr. [Michael] Rankin, to say, 'Hey, would Presbyterian be interested in this more formal partnership?'"

Michael Rankin, MD, who now heads up newborn transfer and is a neonatologist in Presbyterian Hospital's NICU, noted in the phone interview that the telemedicine component was added with the formalization of the partnership, providing "a layer of patient care that wasn't there before."

San Juan Regional purchased an Amwell telemedicine cart to facilitate virtual video consultations with Presbyterian's NICU team. The carts feature cameras, remote camera control, and a touchscreen interface. Some versions have smart sensors and adaptive audio capabilities.

"[The] telemedicine carts are designed to support both in and outpatient care," said Carrie Nelson, MD, chief medical officer at Amwell, in an email. "They are equipped to manage high and low acuity cases to enable timely access to healthcare specialists across the country."

San Juan Regional began using the telemedicine cart in February.

In addition to video-based telehealth consultations with Presbyterian neonatologists, the partnership provides San Juan Regional's clinicians with ongoing medical education. Rankin offers monthly lectures on the latest clinical updates in neonatology.

"[I] go through the core topics relevant to neonatology or newborn care to have the knowledge base stay up to date and strong in Farmington," Rankin said.

Once a quarter, Rankin also brings a multidisciplinary group to Farmington, including nurse educators and respiratory therapists. These clinicians add their knowledge to the lectures and help build deeper connections with the San Juan Regional team, he said.

PATIENT CARE BENEFITS OF VIRTUAL NEONATAL CARE

The patient care advantages of the telehealth partnership are numerous. One of the most significant is the ability to keep infants close to home.

"The telemedicine component…allows us to, I think, more comfortably keep babies closer to home," Scoggins said. "We weren't able to [do that previously] because there was this big chasm in knowledge and experience. Not only from the physicians' standpoint but from the nurses' and respiratory therapists' [standpoint]. If [neonatologists] can literally be at the bedside with the telemedicine piece, I think that helps [our staff] feel a lot better about the quality and type of work that we're doing with babies."

In addition, having a newborn is disruptive in and of itself. Add to that long travel times to faraway care sites, and the disruptions grow manifold, Scoggins noted.

For Presbyterian's team, video-based telehealth enables neonatologists to comfortably see the baby and speak with the care teams on-site, providing specialized care from miles away.

"Within the city of Albuquerque, there're three large NICUs, but then that's about it, and the state is very big," Rankin said. "And so, for us to be able to participate in the care of babies born at outlying hospitals, telemedicine's been really valuable for us."

It also enables the Presbyterian NICU team to establish stronger connections with the loved ones of those they are helping care for. The families can speak with the neonatologists caring for their infants from afar via the telemedicine cart, Rankin noted.

Further, the telehealth partnership has supported San Juan Regional's plans to grow its nursery and pediatric service.

"I read almost on a weekly basis about a pediatric unit in a community hospital that gets shut down," Scoggins said. "One of the downstream effects of that is pushing all this pressure onto children's hospitals, which they find themselves, during pandemics and epidemics, in a difficult position to care for all those kids."

By growing its offerings, San Juan Regional hopes to take the pressure off children's hospitals by not only keeping infants closer to home but also getting them the specialized care they need, he added.

LESSONS LEARNED

Through the process of formalizing the telehealth partnership and deploying the telehealth cart, San Juan Regional and Presbyterian care teams have learned some valuable lessons.

First, establishing a secure connection is paramount. IT teams at both organizations worked together, and with Amwell, to ensure that the technology was working as intended so that clinicians could communicate without interruptions, Rankin said.

Another critical piece is ensuring all physician credentials across the organizations are in place before the partnership is launched.

"We had some different credentialing requirements in place in our hospital, so we had to figure out some of those headwinds in getting the neonatologists credentialed to be telemedicine providers through San Juan Regional," Scoggins said.

Finally, identifying a physician champion can help support the implementation and adoption of new telehealth technology. Scoggins suggests enlisting a clinician who has experience with telehealth and can speak to its benefits to help mentor others on the care team as the technology is deployed.

But it is critical to note that technology is only one layer of any telehealth partnership between two organizations. Clinician communication and collaboration will always be the cornerstone.

"The longer that I'm involved in this career, the more I realize that the entire essence of it is relationship," Rankin said. "Telemedicine allows you to be able to have a more effective relationship with providers who are further away, but you have to see that [relationship] as valuable."