Willard April, Brown Elizabeth, Masten Marjorie, Brant Marisa, Pouppirt Nicole, Moran Kevin, Lioy Janet, Chuo John
Ronald and Harriet Lassin Newborn/Infant Intensive Care Unit, Department of General, Thoracic, and Fetal Surgery (Mss Willard, Brown, and Masten), and Divisions of Neonatology (Drs Pouppirt, Lioy, and Chuo) and Otolaryngology (Mr Moran), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Neonatology, CHOP Newborn Care at Virtua, Philadelphia, Pennsylvania (Dr Brant); and The University of Pennsylvania Perelman School of Medicine, Philadelphia (Drs Pouppirt, Lioy, and Chuo).
Adv Neonatal Care. 2018 Feb;18(1):22-30. doi: 10.1097/ANC.0000000000000460.
Transition from the neonatal intensive care unit (NICU) to home is challenging for caregivers of complex surgical infants. A prospective, observational cohort pilot study using telemedicine to improve transition was implemented in a quaternary level IV NICU.
(1) To assess, identify, and resolve patient care concerns in the immediate postdischarge period. (2) To improve caregiver knowledge and care practices.
Caregivers of medically complex infants participated in telemedicine visits with neonatal providers within 1 week of discharge. Providers reviewed infant health, equipment use, and outpatient follow-up. Video was used to visualize the infant, home environment, and care practices. Caregivers completed a postvisit satisfaction survey.
Ninety-three visits were performed from May 2015 to March 2017. Seventy-six percent of visits were postsurgery patients. Seventy-eight postdischarge issues were identified: medication administration (13%), respiratory (19%), feeding (33%), and surgical site (35%). Fifty percent of caregivers reported that telemedicine visits prevented an additional call or visit to a clinician; 12% prompted an earlier visit (n = 93). Caregiver satisfaction rating was high. Median estimation of total mileage saved by respondents was 1755 miles.
Postdischarge telemedicine visits with complex surgical NICU graduates identify clinical issues, provide caregivers with support, and save travel time. Advanced practice nurses are instrumental in patient recruitment, with patient visits, and in providing postdischarge continuity of care. Barriers to implementation were identified.
A randomized controlled study is warranted to measure the value of telemedicine visits for specific patient cohorts.
对于接受复杂手术的婴儿的照顾者而言，从新生儿重症监护病房（NICU）过渡到家庭是一项具有挑战性的任务。在一家四级NICU开展了一项前瞻性观察性队列试点研究，利用远程医疗来改善过渡情况。
（1）评估、识别并解决出院后即时阶段的患者护理问题。（2）提高照顾者的知识水平和护理实践能力。
患有复杂疾病的婴儿的照顾者在出院后1周内与新生儿医疗服务提供者进行远程医疗问诊。医疗服务提供者审查婴儿健康状况、设备使用情况及门诊随访情况。通过视频查看婴儿、家庭环境及护理实践情况。照顾者完成问诊后满意度调查。
2015年5月至2017年3月共进行了93次问诊。76%的问诊对象是术后患者。共识别出78个出院后问题：用药管理（13%）、呼吸（19%）、喂养（33%）及手术部位（35%）。50%的照顾者报告称远程医疗问诊避免了额外致电临床医生或前往就诊；12%的问诊促使了更早就诊（n = 93）。照顾者满意度较高。受访者估计节省的总里程中位数为1755英里。
对接受复杂手术的NICU出院患儿进行出院后远程医疗问诊可识别临床问题，为照顾者提供支持并节省出行时间。高级实践护士在患者招募、患者问诊及提供出院后持续护理方面发挥着重要作用。确定了实施过程中的障碍。
有必要开展一项随机对照研究来衡量远程医疗问诊对特定患者群体的价值。
