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DOI: 10.1055/a-1977-9102
Telemedizinische Unterstützung der feto-neonatalen Versorgung in einer Region – Teil II: Strukturelle Voraussetzungen und Anwendungsbereiche in der Neonatologie
Telemedical support of feto-neonatal care in one region – Part II: Structural requirements and areas of application in neonatology
Zusammenfassung
Telemedizinische Infrastruktur zur Patientenbeurteilung, -versorgung und -nachbetreuung sowie dem interdisziplinären Austausch kann dazu beitragen, auch außerhalb von spezialisierten Zentren eine wohnortnahe, höchsten Qualitätsansprüchen genügende Patientenversorgung sicherzustellen. In der Neonatologie wird die einrichtungsübergreifende, synchrone audio-visuelle Kommunikation insbesondere im anglo-amerikanischen Raum bereits seit vielen Jahren angewandt. Anwendungsgebiete umfassen dabei die Gebiete der erweiterten neonatalen Erstversorgung und Reanimation, spezifischer diagnostischer Anwendungen, z.B. des ROP-Screenings und der Echokardiografie sowie der elterlichen Betreuung, regelmäßiger telemedizinischer Visiten und der fachlichen Weiterbildung medizinischen Personals, insbesondere unter Nutzung von Simulationstrainings. Für die Implementierung solcher telemedizinischen Infrastrukturen müssen bestimmte organisatorische, medizinrechtliche und technische Anforderungen an Hardware, Software und Struktur- bzw. Prozessorganisation, erfüllt sein. Die konkrete Umsetzung einer aktuell in Implementierung befindlichen telemedizinischen Infrastruktur für die Region Ostsachsen wird hier am Beispiel des Zentrum für Feto/Neonatale Gesundheit (SCFNH) demonstriert. Im Rahmen feto-neontaler Kompetenzverbünde wie dem SCFNH kann mittels einer flächendeckend, gut strukturierten und etablierten telemedizinischen Infrastruktur die medizinische Versorgungsqualität, Patientensicherheit und -zufriedenheit in einer Region erhöht werden.
Abstract
Telemedical infrastructure for patient assessment, care and follow-up as well as interdisciplinary exchange can contribute to ensuring patient care that is close to home and meets the highest quality standards, even outside specialised centres. In neonatology, synchronous audio-visual communication across institutions has been used for many years, especially in the Anglo-American countries. Areas of application include extended neonatal primary care and resuscitation, specific diagnostic applications, e.g. ROP screening and echocardiography, as well as parental care, regular telemedical ward rounds and further training of medical staff, especially using simulation training. For the implementation of such telemedical infrastructures, certain organisational, medical-legal and technical requirements for hardware, software and structural and process organisation must be met. The concrete realisation of a telemedical infrastructure currently being implemented for the region of Eastern Saxony is demonstrated here using the example of the Saxony Center for feto/neonatal Health (SCFNH). Within the framework of feto-neonatal competence networks such as the SCFNH, the quality of medical care, patient safety and satisfaction in a region can be increased by means of a comprehensive, well-structured and established telemedical infrastructure.
Publication History
Received: 16 May 2022
Accepted after revision: 03 November 2022
Article published online:
26 January 2023
© 2023. Thieme. All rights reserved.
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Literatur
- 1 Qualitätssicherungs-Richtlinie Früh- und Reifgeborene – Gemeinsamer Bundesausschuss. Im Internet: https://www.g-ba.de/richtlinien/41/; Stand: 22.08.2022
- 2 Ahmad KA, Velasquez SG, Kohlleppel KL. et al. The Characteristics and Outcomes of Cardiopulmonary Resuscitation within the Neonatal Intensive Care Unit Based on Gestational Age and Unit Level of Care. Am J Perinatol 2020; 37: 1455-1461
- 3 Chung JH, Phibbs CS, Boscardin WJ. et al. The Effect of Neonatal Intensive Care Level and Hospital Volume on Mortality of Very Low Birth Weight Infants. Medical Care 2010; 48: 635-644
- 4 Cifuentes J, Bronstein J, Phibbs CS. et al. Mortality in Low Birth Weight Infants According to Level of Neonatal Care at Hospital of Birth. PEDIATRICS 2002; 109: 745-751
- 5 Hentschel R, Guenther K, Vach W. et al. Risk-adjusted mortality of VLBW infants in high-volume versus low-volume NICUs. Arch Dis Child Fetal Neonatal Ed 2018; fetalneonatal-2018 314956
- 6 Walther F, Küster DB, Bieber A. et al. Impact of regionalisation and case-volume on neonatal and perinatal mortality: an umbrella review. BMJ Open 2020; 10: e037135
- 7 Walther F, Kuester D, Bieber A. et al. Are birth outcomes in low risk birth cohorts related to hospital birth volumes? A systematic review. BMC Pregnancy Childbirth 2021; 21: 531
- 8 Vetter K, Mahlzahn J. Ein Blick in die Zukunft der Perinatalmedizin – Patientensicherheit erfordert die Gestaltung regionaler perinatalmedizinischer Kompetenzverbünde. In: Dormann F, Klauber J, Kuhlen J, Hrsg. Qualitätsmonitor. 2019: 133–147
- 9 Hoffman AM, Lapcharoensap W, Huynh T. et al. Historical Perspectives: Telemedicine in Neonatology. NeoReviews 2019; 20: e113-e123
- 10 Makkar A, Siatkowski RM, Szyld E. et al. Scope of telemedicine in neonatology. Zhongguo Dang Dai Er Ke Za Zhi 2020; 22: 396-408
- 11 Gattu R, Teshome G, Lichenstein R.. Telemedicine Applications for the Pediatric Emergency Medicine: A Review of the Current Literature. Pediatric Emergency Care 2016; 32: 123-130
- 12 McSwain SD, Bernard J, Burke BL. et al. American Telemedicine Association Operating Procedures for Pediatric Telehealth. Telemed J E Health 2017; 23: 699-706
- 13 Vento M, Saugstad OD.. Resuscitation of the term and preterm infant. Seminars in Fetal and Neonatal Medicine 2010; 15: 216-222
- 14 Finer N, Rich W.. Neonatal resuscitation for the preterm infant: evidence versus practice. J Perinatol 2010; 30: S57-S66
- 15 Madar J, Roehr CC, Ainsworth S. et al. European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation 2021; 161: 291-326
- 16 Fang JL, Mara KC, Weaver AL. et al. Outcomes of outborn extremely preterm neonates admitted to a NICU with respiratory distress. Arch Dis Child Fetal Neonatal Ed 2020; 105: 33-40
- 17 Sasaki Y, Ishikawa K, Yokoi A. et al. Short- and Long-Term Outcomes of Extremely Preterm Infants in Japan According to Outborn/Inborn Birth Status*. Pediatric Critical Care Medicine 2019; 20: 963-969
- 18 Fang JL, Carey WA, Lang TR. et al. Real-time video communication improves provider performance in a simulated neonatal resuscitation. Resuscitation 2014; 85: 1518-1522
- 19 Fang JL, Campbell MS, Weaver AL. et al. The impact of telemedicine on the quality of newborn resuscitation: A retrospective study. Resuscitation 2018; 125: 48-55
- 20 Fang JL, Collura CA, Johnson RV. et al. Emergency Video Telemedicine Consultation for Newborn Resuscitations: The Mayo Clinic Experience. Mayo Clinic Proceedings 2016; 91: 1735-1743
- 21 Armfield NR, Donovan T, Bensink ME. et al. The costs and potential savings of telemedicine for acute care neonatal consultation: preliminary findings. J Telemed Telecare 2012; 18: 429-433
- 22 Haynes SC, Dharmar M, Hill BC. et al. The Impact of Telemedicine on Transfer Rates of Newborns at Rural Community Hospitals. Academic Pediatrics 2020; 20: 636-641
- 23 Albritton J, Maddox L, Dalto J. et al. The Effect Of A Newborn Telehealth Program On Transfers Avoided: A Multiple-Baseline Study. Health Affairs 2018; 37: 1990-1996
- 24 Gross IT, Whitfill T, Redmond B. et al. Comparison of Two Telemedicine Delivery Modes for Neonatal Resuscitation Support: A Simulation-Based Randomized Trial. Neonatology 2020; 117: 159-166
- 25 Mileder LP, Bereiter M, Wegscheider T.. Telesimulation as a modality for neonatal resuscitation training. Medical Education Online 2021; 26: 1892017
- 26 Pinheiro JMB.. Leveraging Telemedicine to Spread Expertise in Neonatal Resuscitation. Children 2022; 9: 326
- 27 Jain A, Agarwal R, Chawla D. et al. Tele-education vs classroom training of neonatal resuscitation: a randomized trial. J Perinatol 2010; 30: 773-779
- 28 Kocur I, Resnikoff S.. Visual impairment and blindness in Europe and their prevention. British Journal of Ophthalmology 2002; 86: 716-722
- 29 Tran KD, Cernichiaro-Espinosa LA, Berrocal AM.. Management of Retinopathy of Prematurity – Use of Anti-VEGF Therapy. Asia Pac J Ophthalmol (Phila) 2019;
- 30 Schwartz SD, Harrison SA, Ferrone PJ. et al. Telemedical evaluation and management of retinopathy of prematurity using a fiberoptic digital fundus camera. Ophthalmology 2000; 107: 25-28
- 31 Chiang MF.. Accuracy and Reliability of Remote Retinopathy of Prematurity Diagnosis. Arch Ophthalmol 2006; 124: 322
- 32 Lorenz B, Spasovska K, Elflein H. et al. Wide-field digital imaging based telemedicine for screening for acute retinopathy of prematurity (ROP). Six-year results of a multicentre field study. Graefes Arch Clin Exp Ophthalmol 2009; 247: 1251-1262
- 33 Fierson WM, Capone A. the AMERICAN ACADEMY OF PEDIATRICS SECTION ON OPHTHALMOLOGY, AMERICAN ACADEMY OF OPHTHALMOLOGY, and AMERICAN ASSOCIATION OF CERTIFIED ORTHOPTISTS, et al. Telemedicine for Evaluation of Retinopathy of Prematurity. Pediatrics 2015; 135: e238-e254
- 34 Kostopoulou E, Dimitriou G, Karatza A.. Cardiac Murmurs in Children: A Challenge For The Primary Care Physician. CPR 2019; 15: 131-138
- 35 Song J, Huang X, Zhao S. et al. Diagnostic value of pulse oximetry combined with cardiac auscultation in screening congenital heart disease in neonates. J Int Med Res 2021; 49: 030006052110161
- 36 Webb CL, Waugh CL, Grigsby J. et al. Impact of Telemedicine on Hospital Transport, Length of Stay, and Medical Outcomes in Infants with Suspected Heart Disease: A Multicenter Study. Journal of the American Society of Echocardiography 2013; 26: 1090-1098
- 37 Garingo A, Friedlich P, Chavez T. et al. “Tele-rounding” with a remotely controlled mobile robot in the neonatal intensive care unit. J Telemed Telecare 2016; 22: 132-138
- 38 Makkar A, McCoy M, Hallford G. et al. Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study. Telemedicine and e-Health 2020; 26: 176-183
- 39 Kommers D, Oei G, Chen W. et al. Suboptimal bonding impairs hormonal, epigenetic and neuronal development in preterm infants, but these impairments can be reversed. Acta Paediatr 2016; 105: 738-751
- 40 Ionio C, Colombo C, Brazzoduro V. et al. Mothers and fathers in NICU: The impact of preterm birth on parental distress. Eur J Psychol 2016; 12: 604-621
- 41 Kerstis B, Aarts C, Tillman C. et al. Association between parental depressive symptoms and impaired bonding with the infant. Arch Womens Ment Health 2016; 19: 87-94
- 42 Gibson R, Kilcullen M.. The Impact of Web-Cameras on Parent-Infant Attachment in the Neonatal Intensive Care Unit. Journal of Pediatric Nursing 2020; 52: e77-e83
- 43 Gray JE, Safran C, Davis RB. et al. Baby CareLink: Using the Internet and Telemedicine to Improve Care for High-Risk Infants. Pediatrics 2000; 106: 1318-1324
- 44 Willard A, Brown E, Masten M. et al. Complex Surgical Infants Benefit From Postdischarge Telemedicine Visits. Advances in Neonatal Care 2018; 18: 22-30
- 45 Fang JL, Chuo J.. Using telehealth to support pediatricians in newborn care. Current Problems in Pediatric and Adolescent Health Care 2021; 51: 100952
- 46 Rüdiger M, Heinrich L, Arnold K. et al. Impact of birthweight on health-care utilization during early childhood – a birth cohort study. BMC Pediatr 2019; 19: 69
- 47 Steinhardt A, Hinner P, Kühn T. et al. Influences of a dedicated parental training program on parent–child interaction in preterm infants. Early Human Development 2015; 91: 205-210
- 48 Krupinski EA, Antoniotti N, Brennan D. et al. Core operational guidelines for telehealth services involving provider-patient interactions. American Telemedicine Association 2014; 1-14
- 49 Garingo A, Friedlich P, Chavez T. et al. “Tele-rounding” with a remotely controlled mobile robot in the neonatal intensive care unit. J Telemed Telecare 2016; 22: 132-138
- 50 Jagarapu J, Savani RC.. Development and implementation of a teleneonatology program: Opportunities and challenges. Seminars in Perinatology 2021; 45: 151428
- 51 Garingo A, Friedlich P, Tesoriero L. et al. The use of mobile robotic telemedicine technology in the neonatal intensive care unit. J Perinatol 2012; 32: 55-63
- 52 Fang JL, Asiedu GB, Harris AM. et al. A Mixed-Methods Study on the Barriers and Facilitators of Telemedicine for Newborn Resuscitation. Telemedicine and e-Health 2018; 24: 811-817
- 53 Martins SCO, Weiss G, Almeida AG. et al. Validation of a Smartphone Application in the Evaluation and Treatment of Acute Stroke in a Comprehensive Stroke Center. Stroke 2020; 51: 240-246
- 54 Sakai K, Sato T, Komatsu T. et al. Communication-type smartphone application can contribute to reducing elapsed time to reperfusion therapy. Neurol Sci 2021; 42: 4563-4568
- 55 Join | Allm Inc. Allm Inc | Shaping Healthcare 2021; Im Internet: https://g.allm.net/de/join/; Stand: 20.01.2022
- 56 Broens THF, Huis in’t Veld RMHA, Vollenbroek-Hutten MMR. Determinants of successful telemedicine implementations: a literature study. J Telemed Telecare 2007; 13: 303-309