Implementing Telemedicine Intervention in Neonatal Intensive Care Units: Augmented Teleconsultation and Real-Time Monitoring Experience.

Abstract

Background: Increasing intensivist shortages and demand, coupled with the escalating bed occupancy rate due to increased demand for neonatal intensive care units (NICUs), have created enthusiasm for tele-critical care (TCC) in the form of teleconsultations. Consequently, this study aimed to describe the role of TCC intervention in enhancing NICU capacity to manage discharge, bed occupancy, and neonatal mortality rates.

Methods: This was an uncontrolled, retrospective, interventional descriptive study conducted over 22 months from January 2021 to October 2022 in a public hospital in Najran, Saudi Arabia. We employed the scheduled care model of TCC, in which an intensivist provides daily rounds, overnight calls, and critical care consultations upon request. Real-time outcomes, including mortality, discharge, and bed occupancy rates, were monitored in real-time by the National Healthcare Command Center.

Results: Implementing the TCC program was associated with an overall reduction of 10.7% in the neonatal mortality rate from 10.3 to 9.2 deaths per 1000 live births. The discharge rate increased from 0% in the early months of the TCC application to 34.12% after 4 months of application despite the increased bed occupancy rate. The study revealed no statistically significant difference in mortality rates between the means of pre- and post-TCC (M = 9.74, SD = 4.32), (M = 10.28, SD = 7.99) respectively, p = 0.856 with a 95% confidence interval of -5.58 to 6.66.

Conclusions: TCC in virtual scheduled consultations with a real-time dashboard was proven successful in controlling neonatal mortality and discharge rates. Further studies are required with extended follow-up periods and involving parameters such as the acceptance of physicians, long-term effects beyond the NICU, and the impact of TCC on logistics and resources.