PURPOSE: Inadequate access to care and geographic location remains the biggest factor that adds to the healthcare disparity in our state. 17 out of 55 counties have no birth facilities or prenatal care around their borders. Centers with limited number of births lack experience and resources in taking care of sick infants. To overcome such barriers, a connect-to-care via telemedicine was established as a pilot project in 14 perinatal care facilities in our state. Almost 1/3rd of infants admitted in our level IV NICU are outborn, which comprises 20% of total VLBW infants admitted to our NICU. Our transport program integrated telemedicine in delivering care for emergent and non-emergent transport requests. However this technology remained under-utilized. We hypothesized that inadequate training and education on its benefits are the major barriers for under-utilization of this technology. Our outreach team aimed to provide training on the use and benefits of telemedicine in at least 3 referring facilities per year. METHODS: We developed a mobile simulation center of our own. Mock scenarios were developed and practiced initially for education of transport team members. Once we became proficient in conducting scenarios, mobile simulation was integrated into outreach program. Our telemedicine experts accompany us to promote the incorporation of Telemedicine in transport request. On each visit, we demonstrate the ease with which a tertiary care team can be connected. We ensure the competency on the use of equipment among members of facilities already equipped with telemedicine set-up. We utilize telemedicine for the guidance provided to the learners by neonatologist at our NICU during mock scenarios conducted by outreach team at the referring center. Case scenarios included training on procedures such as intubation, needle decompression, and umbilical line insertion. RESULTS: We visited 7 centers since the launch of this program in spring of 2015. We have found that referral base is more than welcoming to our outreach education program. The feedback included such comments as “new to the area, appreciate putting a face to the name,” “provided an increased knowledge base,” “would like a redo in 6 months, 2 times a year.” The original pilot project sites dusted off their equipment and were able to demonstrate competence in the setup. CONCLUSION: Our innovative outreach education program allowed community hospital physicians and staff to be better prepared in the event of a critical situation. Ongoing outreach training via simulation and integration of telemedicine in the transport request may overcome disparity in care provided to critically sick infants born in a rural center compared to the ones born in a level III/IV NICU.
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Section on Transport Medicine Scientific Program| January 01 2018
Overcoming Perinatal Healthcare Disparity and Transport Program
Cathy L. Richards, RN, BsN, EMT-P, MCCN;
Sanjay Mitra, MD;
Pediatrics (2018) 141 (1_MeetingAbstract): 729.
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Cathy L. Richards, Sanjay Mitra, Christy D. Dixon; Overcoming Perinatal Healthcare Disparity and Transport Program. Pediatrics January 2018; 141 (1_MeetingAbstract): 729. 10.1542/peds.141.1MA8.729
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