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Remote expertise arrives in Tualatin nursery.

by: SUBMITTED PHOTO - Helen Louise Parker and Jennifer Atkinson, both registered nurses at Legacy Meridian Park Medical Center, practice using telemedicine equipment. The screen and camera far left allows them to communicate with remote neonatal specialists by video feed.Cake was not enough to mark the 20th anniversary of the Family Birth Center at Legacy Meridian Park Medical Center this week. Two days after its birthday, the center launched the Tele-Baby Resuscitation program, which uses satellite and robotics technology to give the hospital’s youngest patients even greater odds to survive and thrive.

Telemedicine has long been used by medical professionals to access patients in rural or underserved regions. Tualatin is neither, but without its own neonatal intensive care unit, Legacy Meridian saw the opportunity to use high-resolution video to connect with the neonatal specialists at Randall Children’s Hospital at Legacy Emanuel in Portland.

Through the Legacy Tele-Baby Resuscitation program, a “telemedicine robot” has been on standby in the center since early this week. The screen and camera combination allows a neonatal expert from Randall to be online within 30 seconds, with the ability to rotate the in-nursery camera 360 degrees, and to zoom in to see the infant in high-definition.

“The vision of the project is to create a partnership between community hospitals such as our own and Randall Children's Hospital,” Kimberly Streight, a registered nurse and the nurse manager for Legacy Meridian's Family Birth Center, explained. “It provides us immediate access to neonatal nurse practitioners whose expertise is far beyond ours.”

At the Tualatin hospital, all labor and delivery nurses are required to have a Neonatal Resuscitation Program certification. But Streight estimates that only about one out of every 100 infants delivered at her facility — roughly one a month — ever needs such treatment, so her staff has limited practice with high-risk cases.

“Labor is unpredictable, and problems arise even in low-risk pregnancies and deliveries,” said Dr. Lauren Rose, medical director of Newborn Nurseries at Randall. “It’s very beneficial to have a hands-off remote leader. It allows the team on the ground to tap into the knowledge at the NICU,” where practitioners have a “volume of frequent exposure” to high-risk labors and deliveries.

Randall employs seven neonatal nurse practitioners, and recently hired an eighth due to increased demand from the program.

Streight described Tele-Baby Resuscitation as a “Skype-like program” that enables the remote neonatal expert to act as “the eyes in the sky.”

“(The nurse practitioner) can watch the rise and fall of the baby’s chest, count respiration — all these signs and symptoms that help clue them in on how the baby's doing,” she said.

While the arrangement allows the neonatal expert to supervise and advise remotely, it also allows her to be proactive, Rose said, and think ahead to the next step — which might be calling for further backup.

In this way, the system is expected to improve the continuity of care for infants who ultimately require transportation to the NICU at Randall, which is about a third of infants in crisis at Legacy Meridian, Streight said.

by: SUBMITTED PHOTO - A video feed through this screen and camera combination allows staff at Legacy Meridian Park Medical Centers Family Birth Center to see and speak with neonatal specialists at Randall Childrens Hospital at Legacy Emanuel.Rose agreed. Randall has been on the supporting end of this kind of technology for a year and half, and data shows the time it takes to initiate emergency transport for infants in crisis has dropped by 25 percent.

“In the past, it often required the pediatrician to come onsite and make that determination,” Rose said. “Now, there’s less hesitation to go ahead and call the transportation team. Interventions can happen faster, and we think we can have higher-quality interventions.”

Tele-Baby Resuscitation has doubled the efficiency of other treatments, like neuroprotective cooling, which is often used to prevent brain damage in infants who experience an oxygen shortage during birth.

“And certainly, we think that resuscitating babies well means adhering closely to the algorithm of the Neonatal Resuscitation Program,” Rose said, describing NRP as “CPR for babies.”

“If we can follow the national guidelines as closely as possible, that should have implications in elevating the level of care for these babies,” Rose added.

“Quite honestly, the care the baby receives in that window — a baby’s first few minutes of life — can make all the difference for the outcome of that baby,” Streight said.

While there are few numbers available from the Legacy Tele-Baby program in its first two years, a National Institute of Health study conducted in 2011 found the use of telemedicine technology was associated with a 46 percent decrease in infant mortality in Arkansas hospitals.

Neonatal telemedicine collaboration has been in use at Tuality Healthcare in Hillsboro, as well as at two other Legacy hospitals — Mount Hood Medical Center and Good Samaritan in Portland, where it has aided in 27 procedures since last year. On average, each location uses the Tele-Baby Resuscitation program twice a month, Rose said.

Although Legacy Meridian has yet to put its telemedicine robot to the test outside of training, Streight is excited by the promise of the user-friendly device.

“It’s one more safeguard to make sure we're giving that baby the best possible care,” she said. “This is one way we can insure we can give them that care, even though we're not a level-III nursery hospital.”

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