Neonatal consultation at a distance

Background: Infant transport can be costly, time consuming and risky for both the infant and transport-team. For some infants, telemedicine may improve care, avoid transport and save money. Methods: We conducted an informal retrospective review of the first 10 telemedicine consultations provided from a tertiary perinatal centre to four referring hospitals. Sessions were recorded to allow evaluation of the content of each consultation. Cases of avoided transport were identified by analysis of the recordings and by interviewing the clinicians involved in the consultations. Potential savings resulting from avoided retrievals was estimated in Australian Dollars (AUD) at 2009 prices (AUD 1GUSD0Æ86). Results: Nine consultations were led by a consultant neonatologist and one by a senior registrar. In all cases a paediatrician attended at the referring sites. During sessions, visual information included radiological images (n = 7); infant observation (n = 7); viewing of the patient monitor (n = 2) and ventilator (n = 2). Telemedicine was used to manage requests for infant retrieval (n = 4) and requests for a second opinion (n = 6). This resulted in transport to the RBWH (n = 2), another intensive care nursery (n = 1) and prevented retrieval (n = 3). The total estimated saving from avoided retrievals was $23 618 (Table 1). Conclusion: These early results suggest that neonatal teleconsultation is effective. Anecdotally, the visual information increased safety and confidence in the formulation of local management plans. An infant may be managed in their own community, avoiding costly and risky transport to a tertiary facility using teleconsultation. Further research will formally assess the clinical and economic benefits over a longer time period