Maddox Lory J, Albritton Jordan, Morse Janice, Latendresse Gwen, Meek Paula, Minton Stephen
Intermountain Connect, Intermountain Healthcare, Salt Lake City, UT, United States.
College of Nursing, University of Utah, Salt Lake City, UT, United States.
Front Pediatr. 2021 Apr 23;9:648536. doi: 10.3389/fped.2021.648536. eCollection 2021.
Intermountain Healthcare, an early adopter and champion for newborn video-assisted resuscitation (VAR), identified a reduction in facility-level transfers and an estimated savings of $1. 2 million in potentially avoided transfers in a 2018 study. This study was conducted to increase understanding of VAR at the individual, newborn level. To compare transfers to a newborn intensive care unit (NICU), length of stay (LOS), and days of life on oxygen between newborns managed by neonatal VAR and those receiving standard care (SC). This retrospective, nonequivalent group study includes infants born in an Intermountain hospital between 2013 and 2017, 34 weeks gestation or greater, and requiring oxygen support in the first 15 minutes of life. Data came from billing and clinical records from Intermountain's enterprise data warehouse and chart reviews. We used logistic regression to estimate neonatal VAR's impact on transfers. Negative binomial regression estimated the impact on LOS and days of life on supplemental oxygen. The VAR intervention was used in 46.2 percent of post-implementation cases and is associated with (1) a 12 percentage points reduction in the transfer rate, = 0.02, (2) a reduction in spoke hospital (SH) LOS of 8.33 h ( < 0.01) for all transfers; (3) a reduction in SH LOS of 2.21 h ( < 0.01) for newborns transferred within 24 h; (4) a reduction in SH LOS of 17.85 h ( = 0.06) among non-transferred newborns; (5) a reduction in days of life on supplemental oxygen of 1.4 days ( = 0.08) among all transferred newborns, and (6) a reduction in days of life on supplemental oxygen of 0.41 days ( = 0.04) among non-transferred newborns. This study provides evidence that neonatal VAR improves care quality and increases local hospitals' capabilities to keep patients close to home. There is an ongoing demand for support to rural and community hospitals for urgent newborn resuscitations, and complex, mandatory NICU transfers. Efforts may be necessary to encourage neonatal VAR since the intervention was only used in 46.2 percent of this study's potential cases. Additional work is needed to understand the short- and long-term impacts of Neonatal VAR on health outcomes.
山间医疗集团是新生儿视频辅助复苏（VAR）的早期采用者和倡导者，在2018年的一项研究中发现，机构层面的转诊减少，估计在可能避免的转诊方面节省了120万美元。这项研究旨在增进对个体新生儿层面VAR的理解。比较新生儿VAR管理的新生儿与接受标准护理（SC）的新生儿之间转入新生儿重症监护病房（NICU）的情况、住院时间（LOS）以及吸氧天数。这项回顾性、非等效组研究纳入了2013年至2017年在山间医疗集团的一家医院出生、孕周34周及以上且在出生后15分钟内需要吸氧支持的婴儿。数据来自山间医疗集团企业数据仓库的计费和临床记录以及病历审查。我们使用逻辑回归来估计新生儿VAR对转诊的影响。负二项回归估计了对住院时间和吸氧天数的影响。在实施后的病例中，46.2%使用了VAR干预，其与以下情况相关：（1）转诊率降低12个百分点，P = 0.02；（2）所有转诊的辐条医院（SH）住院时间减少8.33小时，P < 0.01；（3）24小时内转诊的新生儿SH住院时间减少2.21小时，P < 0.01；（4）未转诊的新生儿SH住院时间减少17.85小时，P = 0.06；（5）所有转诊新生儿的吸氧天数减少1.4天，P = 0.08；（6）未转诊新生儿的吸氧天数减少0.41天，P = 0.04。这项研究提供了证据，表明新生儿VAR提高了护理质量，并增强了当地医院让患者在离家较近的地方接受治疗的能力。对于农村和社区医院进行紧急新生儿复苏以及复杂的、强制性的NICU转诊，持续需要支持。由于在本研究的潜在病例中，只有46.2%使用了该干预措施，因此可能需要做出努力来鼓励使用新生儿VAR。还需要进一步开展工作，以了解新生儿VAR对健康结局的短期和长期影响。
