187 - Extending and Sustaining Neonatal Critical Care: A Dedicated Full-Time TeleNeo Critical Care Program’s Success

Publication Number: 187.4971

Stephen D. Minton, Intermountain Health, Provo, UT, United States; Erin Zinkhan, University of Utah School of Medicine, Salt Lake City, UT, United States; Stevie M. Rowe, Intermoutain Health, Orem, UT, United States; Rosemary A. Valencia, Intermountain Health, Draper, UT, United States; Michelle Halgren, Intermountain Health, Murray, UT, United States; Jason Cox, Intermountain Health, Draper, UT, United States; Julie K.. Martinez, Intermountain Health, Murray, UT, United States; Nicholas Carr, Intermountain Health, Sandy, UT, United States; Elizabeth O'Brien, Intermountain Health and University of Utah, Murray, UT, United States

Background: The TeleNeo Critical Care (TNCC) program, launched in 2013, expanded access to neonatal expertise but faced challenges such as increased workloads for in-unit neonatologists, longer connection times, and frequent patient transfers. To address these issues, a full-time TNCC program was introduced in 2022 to reduce telehealth demands, improve connection times, decrease transfers, and support level 2 and 3 NICUs. Over two years, the program grew from 23 to 31 contracted delivery sites and more than 40 non-contracted sites, became primary medical control for the system transport program, and incorporated a novel Urgent Transport Imaging Program (UTIP) to streamline imaging and facilitate faster care for infants with acute surgical needs.

Objective: To evaluate the sustainment and growth of the TNCC program over its two-year implementation.

Design/Methods: Metrics including call volume, acuity, connection times, time to disposition, UTIP utilization, and neonatal transfers were tracked to assess the program’s growth and sustainability. Transfers avoided were measured by identifying complex care cases at a Level 1 nursery that were not transferred to a higher level of care. Complex care cases were defined in part by multiple TNCC consults per patient, need for non-invasive respiratory support, oxygen, and IV access. Length of stay, as a safety balance measure for transfers avoided, was compared between complex care cases and cases of standard TNCC consults.

Results: TNCC supported 895 and 1029 unique patients in its first and second years of operation (Figure 1), representing an 118% increase in consult volume in its second year. Emergent resuscitation calls accounted for 279 (19%) calls. 264 (18%) calls were to facilitate medical control of patient transport. UTIP was utilized in 19 (1%) cases. Only 19 calls (1%) required deferral to in-unit neonatologists. Despite the increase in volume, connection times for emergent cases remained consistent at 1 minute. Furthermore, 216 (24%) of patients required complex care managed by TNCC, successfully preventing transfers and matching year-one success rates. Length of stay was increased by 12 hours for vaginal and 5 hours for cesarean deliveries in complex care cases.

Conclusion(s): The TNCC program achieved substantial growth in its second year, maintaining efficient connection times, reducing telehealth burdens on in-unit neonatologists, and providing comprehensive support across an expanded network of sites. The successful scale-up in year two indicates that further expansion of TNCC can be pursued while sustaining quality and operational efficiency.

Patient flowchart for first two years of dedicated TNCC program
Figure abstract.pdf