In Manitoba, practitioners are geographically distanced and have varied experience and skill. For over 30 years the Neonatal transport program has provided consultative and transport service via telephone prior to travelling to our rural sites with an active obstetrical practice. Videoconferencing provides enhanced service to these communities through high definition visual contact allowing face-to-face discussions and virtual examinations of newborns in remote regions including subspecialty consults. This practice was first implemented in 2001 but was greatly expanded through a joint Manitoba Telehealth – Health Sciences Centre Neonatal Intensive Care Unit project completed in 2012. The goal of this project was to meet Manitoba Health’s Maternal and Child Health Task Force objectives for using telehealth to improve neonatal care. Relationship building was a key to the project’s success and for this reason; services were launched in conjunction with the delivery of the Acute Care of at-Risk Newborns (ACoRN) course in each participating facility. Outcomes included enhancements in urgent transport consultations, discharge planning, family tele-visitations as well as staff participation in educational rounds. Each telemedicine encounter is logged in the NICU and we perform audits of the information every few months to determine the impact in terms of number of transports that have been prevented. By May 1st, 2012 all of the planned sites became operational and therefore we were able to audit 13 months of data to determine impact. From May 1st, 2012 to May 31st, 2013 there were 38 uses of telemedicine for clinical use. Of these, 6 air and 12 ground transports were designated as being averted by the physicians involved in the encounters. At an average cost of $5,000 for ground and $10,000 for air transportation this represents a savings of $120,000 in transportation costs. In none of these cases did an infant require transport at a later stage so in each case patients remained in their communities with the added benefit of this cost savings to the province. Data from 2012 shows a 7-fold increase in clinical telehealth activity from participating rural sites and we are well on our way to replacing telephone with videoconference. We have received accolades from our rural sites have indicated that they feel more supported and confident in managing an ill infant after delivery until the arrival of our transport team. Lastly in some cases, a baby who would have been transported to Winnipeg has been able to stay in their home community through telemedicine support.
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