Pediatric neonatologists save lives beyond the walls of Arkansas Children’s Hospital (ACH) in Little Rock thanks to a growing telemedicine program in nurseries and neonatal intensive care units (NICUs) across the state. The ACH TeleNICU, an outreach program that uses technology to provide live-streamed appointments for critically ill babies in outlying NICU’s, allows ACH neonatologists to virtually support providers.
What is TeleNICU?
Starting in 2022, TeleNICU carts, rolling carts with a mounted tablet, camera and speaker, have been deployed from ACH to several lower-level NICUs and nurseries throughout the state. Matthew Merves, M.D., a neonatologist at ACH and an associate professor of pediatrics in the section of neonatal and perinatal medicine at the University of Arkansas for Medical Sciences (UAMS), is the director of the TeleNICU program.
If there’s a baby in distress, outside physicians call the Arkansas Children’s transport center or dispatch to connect to the ACH NICU, the only highest-rated, level IV NICU in the state. If there’s a case that needs a telemedicine consult, a visit can quickly be established by one of the over 20 ACH NICU neonatologists to support the referring providers.
From there, one of our neonatology experts speak to the referring physician in real time, evaluate the patient on camera and can monitor vitals and review imaging (such as an important X-ray). An ACH neonatologist can also speak to families about their child’s condition. Interpreter options are available.
“In a situation where we know a baby is quite sick and they are coming to Arkansas Children’s, I can start talking with the family and virtually introduce myself before the patient even gets here,” Dr. Merves said.
The video is controlled entirely by the ACH team and is HIPAA compliant to ensure patient privacy. It does not record sessions, but screenshots can be taken from the videos, allowing medical experts to further review important images if needed.
There are currently five TeleNICU carts deployed throughout the state, including UAMS in Little Rock and four ACH Nursery Alliance hospital sites:
- Conway Regional Health System, Conway
- Jefferson Regional Medical Center, Pine Bluff
- Saint Mary’s Regional Medical Center, Russellville
- Saline Memorial Hospital, Benton
The ACH Nursery Alliance started in 2016 as a statewide network to educate and learn from fellow NICUs and newborn nurseries in Arkansas to promote better outcomes for babies statewide.
Dr. Merves said a cart will soon be added to St. Bernards Healthcare in Jonesboro and two more alliance hospital sites within the year.
“The main priority is providing the ability to walk through an exam with the outside physician,” Dr. Merves said. “So, for instance, a baby may have difficulty at delivery and come out stunned. That could be for a whole host of reasons. It could be the umbilical cord gets wrapped around the neck. It could be the baby descends too quickly (moving through the birth canal too rapidly) and gets stuck around the time of birth, and there’s not great blood flow to the brain; a baby may have respiratory struggles, and their color doesn’t look good. We can jump online, walk through an exam with them and assess their need for more specialty care at our ACH NICU. Sometimes, these babies can safely stay at the referring center.”
Jessica Boswell, MBA-OM/HDA, CRS, manager for digital and population health for information services (IS) at ACH, led the vendor selection and contracting process for TeleNICU. She oversees the digital health team, which provides technical support, user training and ongoing education for all TeleNICU cart sites, while supporting ACH team members. Caregility is the current vender of the cart. As a mom of two NICU babies, Boswell said she knew the impact it would have on neonatal care.
“Information services played a critical role in building the infrastructure required to support a program of this complexity. Their expertise was especially valuable as we worked together to design and implement Caregility, making key decisions around provider experience, equipment needs, like camera and microphone placement, and even the height of the carts to ensure our experts had the best view of the baby,” Boswell said. “In partnership with our operations center, we developed a streamlined documentation workflow within Epic, our patient chart program. If a patient seen through TeleNICU requires transport to ACH, the receiving clinical team can access all relevant evaluations and findings quickly, even if they weren’t involved in the initial consult.”
How beneficial are NICU telemedicine assessments?
On average, the ACH NICU has one or two telemedicine sessions a week from TeleNICU hospital sites. While the goal is not to change referral patterns, early pilot data showed that roughly a third of those patients could safely remain at the referring hospital.
“A baby can still be fully assessed, but then they can, sometimes, stay at the delivery hospital with their parents instead of separating them,” Dr. Merves said.
The ACH NICU partners with pediatric neurology to provide specialized care for newborns in the
neonatal neurocritical care program. A key part of the program is therapeutic hypothermia, or whole-body cooling, a clinical treatment of intentionally lowering an infant’s body temperature for 72 hours to reduce brain damage after an injury.
Dr. Merves said assessing via a telemedicine session whether a newborn has a significant injury that would potentially benefit from cooling is very important and requires timely, informed decision making.
“We can be an extra remote provider at these sites to help stabilize the baby until our very skilled transport team can arrive and get the baby here,” Dr. Merves said.
TeleNICU is starting to explore non-urgent, subspecialty consults where a baby at an outside nursery or NICU can have a more formal consultation with a specialist at Arkansas Children’s.
“We are starting with
Dr. Sarah Cobb (a pediatric neurologist at ACH and assistant professor in the department of pediatrics in neurology at UAMS). The outside provider can call Arkansas Children’s, they can create a chart for the patient at our hospital. She can utilize the TeleNICU cart there to do her exam, see the patient and have that first visit safely inside the institution,” Dr. Merves said.
'Calming presence’
Over the years, our pediatric neonatology experts have used TeleNICU to change lives.
Ashley Lynch, M.D., a pediatric neonatologist and assistant professor of pediatrics at UAMS, said seeing a patient and the medical team virtually can reduce confusion.
“I had an experience over the phone where they did CPR on a baby. It was difficult to discern who was talking because you couldn’t see faces. I was hoping what I was saying was making it to the right person. There’s a lot of extra requests for clarification,” Dr. Lynch said. “With the TeleNICU cart, I can see who I’m talking to and confirm they hear me. Also, seeing family’s faces while I’m talking to them is a much more palatable experience.”
Dr. Lynch recalled once spending several hours helping advise and partner with the medical team at Saint Mary’s Regional Medical Center, a nursery alliance member site.
“That team was relentless in providing care for the baby. From start to finish, the collaboration between us and between that team was powerful,” Dr. Lynch said. “I could move the camera and focus in. I was able to see everything that I needed to see. It made me almost forget that I wasn’t physically in the room. I felt like I had the tools that I needed to help them make decisions.”
Morgan Keeling, MSN, R.N., CPN, director of Women’s and Children’s Services at Saint Mary’s, said her team was thankful for Dr. Lynch’s support.
“Dr. Lynch was the most encouraging and calming presence,” Keeling said. “Between laying eyes on the baby, collaborating with us on medication dosing based on the concentrations we had at our hospital and reassuring our team that we were doing a great job throughout the chaos, every nurse, obstetrician and pediatrician that was present has spoken to how impressed they were with her.”
Imagining what’s next
Beyond expanding the telemedicine sessions to more hospitals and more specialty consults, Dr. Merves said they are exploring how the program can do even more for patients. They are working on the ability to save screenshots from telemedicine sessions into a patient chart.
“Let’s say the patient had a physical exam finding, and we couldn’t get an ear, nose and throat (ENT) specialist on the phone. I could take a screenshot, save it and then talk with the ENT experts to take a look,” Dr. Merves said. “The other thing I like is being able to share content. This is more from an educational standpoint, but I could pull up a photo that explains a typical finding that matches what they’re showing me and talk through that diagnosis with them.”
They can also utilize the tool for remote educational simulation work with nursery alliance partners, even sharing fictitious vital signs on the screen to demonstrate how a patient’s vitals should appear in various scenarios.
Dr. Merves has also been imagining what innovation is next for TeleNICU. He’s working with Caregility on an improved prototype for the carts.
“We’re working on a prototype to have a little bit of a boom arm for the camera, where they can wheel the cart next to the bed, but then we can even extend the view out over the patient, so we’re not as much in the way of all the other providers, but really able to get above the patient,” Dr. Merves said. “A lot of the audio considerations are different, so they’ve been working with different vendors to optimize the speaker.”
TeleNICU allows level IV NICU care to extend to every corner of the state, beginning with our partner sites, giving new parents extra peace of mind.
“The TeleNICU program is helpful as we create more of a network. Arkansas Children’s is at the center of the hub with all these spokes, but we can also have bidirectional sharing of patients,” Dr. Merves said. “There’s more and more maternal deserts as physicians move out of state or the region. TeleNICU allows participating sites to have extra support, even before our transport team can get there.”
*This article was written by the Arkansas Children’s content team and medically reviewed by Matthew Merves, M.D.
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