vNICU Research
To improve the health outcomes of seriously ill infants, we are determining whether it is safe, effective and feasible to provide neonatal intensive care via telemedicine. Given the scarcity of existing research in this field, our project will make a substantive contribution to the practice of neonatal medicine.
Demonstration of vNICU Equipment
To demonstrate that the vNICU equipment meets specified technical standards, we established an 8 a.m. start time for the system to be operational each day. We assess:
- Quality of transmitted images, sounds and data
- Sustainability of the video-connection
- Delays (if any) in data transmission
With improvements in camera resolution and zoom, we anticipate that patient images transmitted to our hospital via telemedicine will be more detailed than what physicians experience at the infant’s bedside.
Patient Monitoring
The on-site and virtual neonatologists began monitoring infants treated in the San Gabriel Valley Medical Center NICU. All of the neonatologists participating in the study have a similar level of training and experience, and board-certification in perinatal-neonatal medicine. They measure the ability of staff in both locations to:
- Properly identify patients using their name, medical record number and date of birth
- Evaluate patients based on their vital signs (e.g., temperature, heart rate, respiratory rate, oxygen saturation, blood pressure), physical characteristics (e.g., weight, age), and review of test results (e.g., images of chest x-rays, abdominal x-rays, ultrasound images)
- Determine the patient’s level of comfort (a pain assessment tool used by Children's Hospital Los Angeles will be utilized)
These health indicators are assessed at each patient encounter and recorded, and the results are compared by a panel of senior neonatologists.
Based on their appraisal of the infant’s condition, the virtual and on-site neonatologists each develop a treatment plan, which is submitted to a panel of senior faculty for review. Any differences and their potential impact on patient safety are evaluated based on the hospital’s standard clinical guidelines. Please note that in the first phase of the study our standard of care will not change since patients will be treated by the on-site neonatologist. The evaluation and hypothetical care plan developed by the virtual neonatologist will only be used for comparative purposes.
Biostatistics
Inter-rater reliability is calculated using Kappa statistics and sample size calculations are based on an alpha level of 0.05 with a power of 0.90. To test our hypothesis that the inter-rater reliability of tested measurements has a 98% agreement, a sample size of approximately 1,200 patient encounters are required.
Phase One Findings
Phase one results indicate that the use of a remote-controlled, robotic telemedicine system in a NICU is feasible and safe. Telemedicine technology aptly provides off-site neonatologists with direct visual and auditory information about the patient and the clinical scenario in real-time in order to facilitate decisions about clinical care. In addition, the system could be useful for providing immediate consults for emergencies occurring in a community hospital NICU by subspecialists and neonatologists available 24-hours per day at an associated children's hospital or larger medical center.
