Couturier Katherine, Whitfill Travis, Bhatnagar Ambika, Panchal Rajavee A, Parker John, Wong Ambrose H, Bruno Christie J, Auerbach Marc A, Gross Isabel T
Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
BMJ Simul Technol Enhanc Learn. 2019 Dec 24;6(1):10-14. doi: 10.1136/bmjstel-2018-000398. eCollection 2020.
The delivery and initial resuscitation of a newborn infant are required but rarely practised skills in emergency medicine. Deliveries in the emergency department are high-risk events and deviations from best practices are associated with poor outcomes.
Telemedicine can provide emergency medicine providers real-time access to a Neonatal Resuscitation Program (NRP)-trained paediatric specialist. We hypothesised that adherence to NRP guidelines would be higher for participants with access to a remotely located NRP-trained paediatric specialist via telemedicine compared with participants without access.
Prospective single-centre randomised trial. Emergency Medicine residents were randomised into a telemedicine or standard care group. The participants resuscitated a simulated, apnoeic and bradycardic neonate. In the telemedicine group a remote paediatric specialist participated in the resuscitation. Simulations were video recorded and assessed for adherence to guidelines using four critical actions. The secondary outcome of task load was measured through participants' completion of the NASA Task Load Index (NASA-TLX) and reviewers completed a detailed NRP checklist.
Twelve participants were included. The use of telemedicine was associated with significantly improved adherence to three of the four critical actions reflecting NRP guidelines as well as a significant improvement in the overall score (p<0.001). On the NASA-TLX, no significant difference was seen in overall subjective workload assessment, but of the subscore components, frustration was statistically significantly greater in the control group (p<0.001).
In this study, telemedicine improved adherence to NRP guidelines. Future work is needed to replicate these findings in the clinical environment.
新生儿的分娩及初始复苏是急诊医学中必需但很少实践的技能。在急诊科进行分娩是高风险事件，偏离最佳实践会导致不良后果。
远程医疗可为急诊医学提供者提供实时途径，使其能联系到接受过新生儿复苏计划（NRP）培训的儿科专家。我们假设，与无法联系到此类专家的参与者相比，通过远程医疗能联系到远程的、接受过NRP培训的儿科专家的参与者对NRP指南的遵循度会更高。
前瞻性单中心随机试验。急诊医学住院医师被随机分为远程医疗组或标准护理组。参与者对一名模拟的、呼吸暂停且心动过缓的新生儿进行复苏。在远程医疗组中，一名远程儿科专家参与复苏过程。模拟过程进行视频记录，并使用四项关键操作评估对指南的遵循情况。通过参与者完成美国国家航空航天局任务负荷指数（NASA-TLX）来衡量任务负荷这一次要结果，评审者完成一份详细的NRP检查表。
纳入了12名参与者。使用远程医疗与在反映NRP指南的四项关键操作中的三项操作的遵循度显著提高相关，同时总体评分也有显著改善（p<0.001）。在NASA-TLX上，总体主观工作量评估未见显著差异，但在子评分项目中，对照组的挫败感在统计学上显著更高（p<0.001）。
在本研究中，远程医疗提高了对NRP指南的遵循度。未来需要开展工作以在临床环境中重复这些发现。
