Robot Joins Neonatal Nursery Team
It was a tense situation - one no new parent wants. The baby girl – though small – seemed the picture of health after birth. Then the baby began to cry and worsen before their eyes as she developed complications from her premature birth. Phone consultations with neonatal experts at Rocky Mountain Children's Hospital at Presbyterian/St. Luke's (RMCH at PSL) were not enough to confirm the diagnosis Dr. Greg Miranda at Vail Valley Medical Center suspected. Even as the symptoms progressed, the specialists needed to see, to test the baby to be certain.
But they were in Denver. The baby was in Vail. Should the little girl be transferred?
Then, the Vail Valley Medical Center (VVMC) Pediatric Team remembered the new tool in their arsenal, the robotic camera. It had only been used for telemedicine consults with cardiologists and stroke specialists in Denver in its nearly eight years at VVMC, but recent enhancements now allowed VVMC to use it for pediatric purposes, too. Within 10-15 minutes, the mountain-based team and sub-specialists in the NICU (Neonatal Intensive Care Unit) at RMCH at PSL were connected remotely for a virtual consult via the robotic camera. Neonatologists Dr. Jeff Hanson and Dr. Jan Kennaugh could now not only speak to Dr. Miranda and his team at VVMC, but see the baby real-time as she lay on the warmer. They were able to examine the ultrasounds and x-rays remotely, zooming in for better details, rotating views or panning out to see baby and physician. “Basically,” says Dr. Miranda, “they were in the room remotely.” The virtual consult confirmed what all three physicians suspected. The baby needed transport to Denver for specialized care.
“The most important aspect from my point of view is the 'real-time' ability to discuss virtually, face-to-face with the referring or consulting physician,” explains Dr. Kennaugh. “Oftentimes, a verbal description of the patient's status, whether it be breathing, skin rash or dysmorphic (congenital) features, doesn't give as complete a picture as the actual visual image.”
Firsts in telemedicine
Vail Valley Medical Center is the first hospital in the state to have NICU Transfer Stabilization Consult capability offered by the CO-Doc Telemedicine Network, which is a division of HealthONE.
“Vail Valley Medical Center is continuously exploring avenues to bring expert and specialist care to Vail so the families in this community are not forced to make stressful trips away from home in times of crisis,” states Doris Kirchner, president and CEO of Vail Valley Medical Center. “VVMC is pleased to offer NICU telemedicine capabilities for families in the valley. The NICU Transfer Stabilization Consult capability and the RP Lite Remote Camera add a new level of assurance, compassion and care to our already excellent Neonatal Team.”
Dr. Miranda, a Pediatric Hospitalist with the Pediatrix Medical Group at Vail Valley Medical Center is also enthusiastic for the future of telemedicine possibilities for the neonatal unit in Vail. He points out at least once a month it is necessary for his team to contact specialists outside the valley about pediatric cardiology, neurology, G.I. problems or lung problems in children. “If there is an emergent situation, we can have an immediate neonatal presence in the room,” he states. Plus, the opportunity exists, if needed, to have neonatal experts guide physicians in Vail through a patient procedure.
The Neonatologists, such as Dr. Hanson and Dr. Kennaugh, control the small, five-foot high RP Lite robotic camera from a slick Access Center located at RMCH in Denver. Using a joystick, they can virtually move around the room, providing views of patient, physician, x-rays or ultrasounds. The images are sent back to multiple computer screens, laptops or iPads in the Access Center with extraordinary precision and clarity.
“One of the goals of telemedicine is to determine whether the patient transfer is necessary,” explains Megan Canter, Director of Telemedicine at the CO-Doc Telemedicine Network. The CO-Doc Telemedicine Network has 33 robotic units deployed around the state. CO-Doc also has engaged a Neonatologist for Airlife transport fitted with a neonatal flight team. “If I'm a mom, and I have my baby taken from me, and I don't know where she is going, and she's taken by helicopter, I'm scared,” observes Canter. With the NICU Transfer Consult, she points out, “your family can have the opportunity to meet and interact with the doctor preparing for your patient once you arrive.”
CO-Doc first forged its relationship with VVMC with the addition of a stroke camera in 2006, when VVMC became one of the first six sites where telemedicine robots were deployed. Since then, telemedicine has expanded to other arenas. Having just achieved a first by acquiring and using the NICU Transfer Stabilization Consult, VVMC is about to embark on another first.
Soon, VVMC will be the first hospital in the state to have four different remote camera service lines in place for four different telemedicine specialties. The Co-Doc Telemedicine Network is now working with VVMC to develop pediatric echocardiogram capabilities through remote viewing, as well as high-risk maternal/fetal monitoring, useful to keep abreast of issues such as a high-risk pregnancy or a baby born with mild congenital heart issues, eliminating much of the need for traveling to Denver to get all the advantages of specialist care.