One in ten.

Those are odds no prospective parent wants to hear, but in the United States today, 10 percent of all births happen before the 37th week of pregnancy. Approximately 40,000 infants require extensive resuscitative measures every year. Providing instant access to innovative services and technology will increase the odds these infants survive their difficult first days, go home with their parents and go on to lead full, healthy lives.

Virtual health programs offer this instantaneous support.

Tele-NICU programs give on-site clinicians and neonatal nurse practitioners (NNPs) the ability to connect with world-class, board-certified neonatologists in the crucial moments and days after an unexpected delivery. By being virtually present during a patient encounter, neonatologists can help make critical decisions that will directly impact and improve patient outcomes, reduce the need for transport and enhance the care that community pediatricians and family medicine physicians provide even after tiny patients have been discharged.

According to UNICEF, while neonatal mortality has been declining globally, its downward trajectory is slower than the drop in mortality for older infants (one to 11 months) and young children (age one to four). This trend was true even in North America.

Reducing neonatal mortality rates becomes increasingly difficult as more neonatal intensive care units (NICUs) close. These units are some of the first services to disappear when hospitals start to struggle financially, even though the absence of NICUs exacts an enormous emotional and financial toll on community residents.

Rural healthcare systems are having an especially difficult time serving their most fragile patients and their families.

Easton Hospital in Easton, Penn., closed its six-bed NICU in 2019 after the number of visits decreased by half between 2013 and 2017. A hospital in Antioch, Calif., shuttered its NICU in January 2021, citing the financial impact of the COVID-19 pandemic and declining birth rates in the region. The California Nurses Association protested. In a press release, the organization noted, “After the closure, sick babies will be transported to other facilities, potentially placing patient safety in jeopardy.” The nurses also argued the closures would “leave infants in their first hours of life vulnerable to the worst possible outcomes.”

National Public Radio and several other news outlets reported in 2019 that a Virginia woman about to deliver her baby about 28 weeks was charged $44,000 for a 44-minute ambulance ride to a Tennessee NICU. Journalists noted, “a decade ago” that mother “could have found an emergency room, if not a NICU, 10 minutes up the road.”

Too many critical access hospitals and rural communities no longer have a neonatologist within convenient traveling distance. Other facilities are worried about safety and the threat of litigation – or they are simply thinking about how to build a hospital that responds to market forces. (Preterm births are devastatingly common, but, as the data cited from Pennsylvania and California show, they are infrequent enough that it is hard to keep a full-time team devoted to the potential need).

These barriers to healthcare access certainly contribute to the United States’ higher-than-the-developed country average for infant mortality. Indeed, preterm birth is still the second leading cause of infant mortality in the United States.

According to the Advisory Board, there are 20 fewer physicians per 10,000 people in rural areas than there are in urban areas. These shortages, the Advisory Board has said, are due to an overall declining rural population, rural underrepresentation in medical schools and generational shifts in preferences for cities over small towns.

Additionally, as a 2019 report from the American Academy of Pediatrics (AAP) showed, the demand for neonatal nurse practitioners (NNP) “outpaces the supply.” One reason is age. The average NNP is 49 years old. Burnout also is a significant issue. About three-quarters of NNPs report they “worked at least 35 hours per week” while more than half regularly worked more than their scheduled hours because of persistent gaps in coverage.

Clinician shortages result in hospitals having no organized guidance and expertise for emergent neonatal resuscitation standards and no resource for general pediatricians to serve special care nursery infants.

The AAP report said strategic modeling indicates NNP shortages could persist well into the next decade “unless innovative recruitment and retention strategies are used to deal with this issue.” Improved talent recruitment programs certainly are part of the answer, but virtual health programs also can help fill gaps in NICU coverage.

The hub and spoke model of healthcare and virtual health has been in existence for many years. It has worked, but with new innovations in technology – and greater access to broadband – the promise of virtual health is ready to be realized on a wider scale. The opportunity should be especially attractive for hospitals and health systems who want to keep serving their community by keeping their NICU open.

Virtual health programs in the NICU can help on-site clinicians review scans, lab results and vital signs; make more thorough patient assessments; assist with diagnoses; and supplement daily rounds. Technology also makes it easier for clinicians and parents to keep in contact. That benefit has been especially welcome during the COVID-19 pandemic but is important outside of public health crises as well. Mothers who deliver via c-section often are not able to make the short trek to the NICU. Virtual health tools can provide them the chance to see their babies in the immediate days after a difficult birth.

Our Tele-NICU program offers 24 hour, seven day a week access to a national network of board-certified neonatologists. These clinicians are able to support level one nurseries or supplement level two nurseries with in-house advanced practice providers (APPs) – meaning care comes at the fraction of a cost of an in-house physician. Hospitals gain immediate access to a face-to-face visit for emergencies and for every parent interaction. Our neonatologists also are available to provide well newborn coverage all day, 365 days a year.

Premature Births

A key part of our program is ongoing training and metric tracking. Individuals on both sides of our state-of-the-art audio/visual technology are trained and updated on using dynamic virtual health tools. We also offer virtual educational programs for hospital teammates and work with hospital and health system leadership to continuously track data and key performance indicators.

Working with hospitals, we also have incorporated virtual health into post-discharge consultations. About 20 percent of premature infants are re-admitted to the hospital in their first year of life. The cost to families, and the facility, is enormous. Hospitalization costs in that first year average more than $50,000, and a majority of those levies occur in the first two weeks after discharge. Our virtual Neonatal Support Program can help cut the post-NICU discharge gap, reduce future visits to the emergency department or urgent care, and prevent families from seeking care elsewhere.

A study published in the journal Telemedicine and e-Health in February 2020 evaluated the safety and efficacy of the treatment of premature infants managed by a hybrid telemedicine system in a satellite level two NICU at Comanche County Memorial Hospital in Lawton, Okla. and a regional level four NICU at Oklahoma University Medical Center. It concluded virtual health “is a safe and cost-effective way to extend intensive care to late premature neonates in medically underserved areas.” The study also noted, “parental satisfaction with the use of hybrid telemedicine was particularly high, due to reductions in transportation difficulties, as the infants were able to stay at a local hospital without compromising the quality of care.”

A three-year investigation published in 2016 by Mayo Clinic also found NICU virtual health services helped improve the quality of care.

Mayo worked with NICU teams in both rural, small hospitals and in low-income, urban areas that were ill-equipped to handle newborn emergencies. According to MedCityNews, engagement via virtual health prevented transfers and helped stabilize infants before transfer. One-third of the cases resulted in the newborn remaining in the hospital where they were born. The Mayo Clinic teams even were able to help resuscitate twin girls born at 22 weeks so the parents could spend some time with them. According to MediCityNews “every transfer avoided saved the system $35,000, for a total of more than $1 million” over three years.

The Mayo Clinic also reported clinicians were eager to embrace virtual health in the NICU. In fact, nearly 96 percent of local physicians said they would use virtual health technology again and would recommend it to their colleagues. Ninety-five percent said virtual health consults improved patient safety and the quality of care.

Adding virtual health to a NICU provides appropriate backup for overextended on-site physicians; reduces the need for patient transport; increases bed utilization and discharge timeliness; and offers support after discharge for families, community pediatricians and family medicine physicians.

It is a lifeline for hospitals and health systems that are dealing with financial strain and persistent understaffing.

The most important outcome, though, is for our babies. By providing immediate support during neonatal emergencies – and improving safety and resuscitative efforts – virtual health technology will help more babies get home and on the path toward a healthy life.

Envision Virtual Health Services can help you deliver better outcomes and patient experience by keeping care within your community. Want to learn more?

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