Developing a Newborn Resuscitation Telemedicine Program: A Comparison of Two Technologies

Abstract

Background: Early work has demonstrated the feasibility and acceptance of newborn resuscitation telemedicine programs (NRTPs). The technology requirements for providing this type of emergency telemedicine service are unclear.

Introduction: We hypothesized that during NRTP consults, a wired telemedicine cart would provide a more reliable and higher-quality user experience than a consumer-grade wireless tablet.

Materials and methods: In this retrospective observational study, six spoke sites used consumer-grade wireless tablets during preintervention and wired coder/decoder (CODEC)-based telemedicine carts during postintervention. Both technologies used the same videoconferencing software. After the telemedicine consult, providers completed surveys assessing connection reliability, user satisfaction, and audio and video quality using a 1-5 Likert scale.

Results: Preintervention, users completed 99 consults and 95 surveys. Postintervention, users completed 73 consults and 192 surveys. Successful connection on first attempt was significantly improved with the wired cart compared with the wireless tablet (82.7% vs. 69.5%, p = 0.01), and the percentage of consults complicated by an unplanned disconnection was reduced (6.4% vs. 14.7%, p = 0.02). User satisfaction and video and audio quality ratings were significantly higher for the wired cart.

Discussion: The wired telemedicine cart increased connection reliability, which is important given the critical nature and long duration of NRTP consults. Audio-video quality was also improved, allowing for better visualization of the neonate and communication with the care team.

Conclusions: Consumer-grade wireless tablets did not meet the program's technical requirements. Wired telemedicine carts improved reliability, user satisfaction, and audio-video quality. Wired carts may not fully meet NRTP requirements because of cart size and limited mobility.

Keywords: pediatrics; technology; telemedicine.

Fig. 1.

Newborn resuscitation technology program consult process. This swim lane diagram outlines the process steps completed by the local care team, the admission and transfer call center, and the remote neonatologist during a newborn resuscitation telemedicine consult.

Fig. 2.

Wireless network analyzer that demonstrates 24 service set identifiers (SSIDs), channel overlap, and fluctuating radiofrequency power levels.

Fig. 3.

Newborn resuscitation technology program technology. (A) Wired telemedicine cart equipped with a hardware CODEC, high-definition pan-tilt-zoom camera, and a microphone-speaker set. (B) Wired telemedicine cart positioned in the delivery room during a simulated newborn resuscitation. CODEC, coder/decoder. Published with the permission of the participants; used with permission of the Mayo Clinic.

Fig. 4.

Additional audio and video quality metrics and cart usability metrics measured in the postintervention period. Error bars represent one standard deviation from the mean.