J.H.L. Wagenaar

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Journal article (5)

5 records found

Implementation and effectiveness of Teleneonatology for neonatal intensive care unit consultations in the Netherlands

A hybrid type III implementation pilot

Journal article (2025) - Josephine H.L. Wagenaar , Julia Broos , Saba Hinrichs-Krapels , Irwin K.M. Reiss , H. Rob Taal , Ron H.T. van Beek , Henrike Pas , Martijn Suurveld , Anne Jacobs , Fredrik Bodell , Sylvia A. Obermann-Borst , Florian Cassel , Maaike S. Kleinsmann

Background: Real-time audiovisual communication between healthcare providers (HCP) at different hospitals (TeleNeonatology) can improve neonatal outcomes, address capacity challenges, and reduce emotional burden on parents. Despite its potential, TeleNeonatology has yet to be widely implemented in routine clinical care, partly due to non-optimal integration into care pathways and working routines. To provide insights for further adoption, this study presents the evaluation of a pilot in the Netherlands. Methods: A prospective hybrid type III effectiveness-implementation study was conducted in 2024. During the pilot, a TeleNeo program facilitated both acute and elective communication between Erasmus MC NICU-level IV and Amphia NICU-level II. The TeleNeo program was developed and continuously improved during the pilot using co-creation with HCP and parents to enable embedding in care pathways and working routines. A mixed-methods approach was used for evaluation. The primary outcome was a validated 21-item usability questionnaire with five-points Likert Scale questions for parents (n = 50) and HCP (n = 85). Implementation determinants were evaluated with semi-structured interviews and surveys. Effectiveness was measured via parent reported experiences, and clinical outcomes length-of-stay and transfer rate. Results: Twelve months of implementation led to 99 consultations for 50 patients and families, including 33 acute patients, possibly in need of an acute transfer. Evaluation showed high feasibility and adoption. Usability was high among parents (n = 26, median score 5 [interquartile rage: 4–5]) and HCP (n = 48, median score 5 [interquartile range 4–5]). Parents valued rapid expert availability, involvement in transfer decisions, and experienced shared care between the NICUs. HCP observed quick and approachable communication, quicker medical decisions, improved quality of care, and smoother transitions between NICUs. Nurses were able to be more pro-active. In 18% (6/33) of acute cases transfers were perceived to be prevented. HCP highlighted TeleNeo’s influence on the local teams’ autonomy, communication styles, and financial aspects as important barriers in interviews (n = 12) and questionnaires (n = 65). Conclusions: Pilot implementation showed high feasibility of our TeleNeo program, enabling shared care at the optimal location for our patients. Our findings will guide a robust strategy for implementation in the Southwest of the Netherlands, enhancing neonatal care, parental satisfaction and nursing experience.

Impact assessment of neonatal care interventions on regional neonatal care capacity

A simulation study based on clinical data in the Netherlands

Journal article (2025) - Josephine H.L. Wagenaar , Alexander Dietz , Yilin Huang , Irwin K.M. Reiss , Jasper V. Been , Jessie Spaan , René F. Kornelisse , Hendrik Rob Taal , Saba Hinrichs-Krapels

Objective To analyse the impact of selected neonatal care interventions on regional care capacity.Design Discrete event simulation modelling based on clinical data.

Objective To analyse the impact of selected neonatal care interventions on regional care capacity.

Design Discrete event simulation modelling based on clinical data.

Setting Neonatal care in the southwest of the Netherlands, consisting of one tertiary-level neonatal intensive care unit (NICU), four hospitals with high-care neonatal (HCN) wards and six with medium-care neonatal (MCN) wards.

Participants 44 461 neonates admitted to at least one hospital within the specified region or admitted outside of the region but with a residential address inside the region between 2016 and 2021.

Interventions The impact of three interventions was simulated: (1) home-based phototherapy for hyperbilirubinaemia, (2) oral antibiotic switch for culture-negative early onset infection and (3) changing tertiary-level NICU admission guidelines.

Main outcome measure Regional neonatal capacity defined as: (1) occupancy per ward level, (2) required operational beds per ward level to provide care to all inside region patients at maximum 85% occupancy, (3) proportion rejected, defined as outside region transfers due to no capacity to provide local care and (4) the weekly rejections in relation to occupancy to provide a combined analysis.

Results In the current situation, with many operational beds closed due to nurse shortages, occupancy was extremely high at the NICU and HCNs (respectively 91.7% (95% CI 91.4 to 92.0) and 98.1% (95% CI 98.0 to 98.2)). The number of required beds exceeded available beds, resulting in >20% rejections for both NICU and HCN patients. Although the three interventions individually demonstrated effect on capacity, clinical impact was marginal. In combination, NICU occupancy was reduced below the 85% government recommendation at the cost of an increased burden for HCNs, highlighting the need for redistribution to MCNs.

Conclusion Our model confirmed the severity of current neonatal capacity strain and demonstrated the potential impact of three interventions on regional capacity. The model showed to be a low-cost and easy-to-use method for regional capacity impact assessment and could provide the basis for making informed decisions for other interventions and future scenarios, supporting data-driven neonatal capacity planning and policy development.

First in-human pilot study of wearable phototherapy for neonatal hyperbilirubinaemia

Journal article (2025) - Jessie Spaan , Jasper V. Been , Yanera Wallé , Irwin K.M. Reiss , Josephine H.L. Wagenaar , Christian V. Hulzebos , Berthe A.M. van der Geest

This pilot study aimed to assess the effectiveness and safety of the first wearable phototherapy device in (near-)term neonates with unconjugated hyperbilirubinaemia. This prospective single-arm intervention pilot study was conducted in the Erasmus MC Sophia Children’s Hospital m ...

Implementation and effectiveness of teleneonatology for neonatal intensive care units

A protocol for a hybrid type III implementation pilot

Journal article (2025) - Josephine Wagenaar , Ron Van Beek , Henrike Pas , Martijn Suurveld , Naomi Van Der Linden , Julia Broos , Maaike Kleinsmann , Saba Hinrichs , H. Rob Taal

Background: Telemedicine in neonatal care (TeleNeonatology) has the potential to improve neonatal outcomes, address capacity challenges and influence the emotional burden on parents. TeleNeonatology allows for real-time audiovisual communication between healthcare providers at different neonatal intensive care units (NICUs). Despite the high potential for multiple neonatal use-cases, TeleNeonatology is primarily being used for neonatal resuscitation and has yet to be widely implemented in Europe. Our study aims to evaluate both implementation strategies and effectiveness of TeleNeonatology in a pilot study in The Netherlands.

Methods: A pre-post implementation study with hybrid type III design will be conducted from 1 January 2023 to 31 December 2024. The year 2023 will serve as a baseline period pre-implementation. From 1 January 2024, a TeleNeonatology device will be integrated within all communication between the NICU-level IV of the Erasmus MC hospital and the NICU-level II at Amphia Hospital. Outcomes of the implementation of the TeleNeo programme will be evaluated using a mixed-methods approach evaluating implementation outcomes, service outcomes and client outcomes. Feasibility, the primary implementation outcome, will be evaluated via a validated questionnaire for parents and personnel. Secondary implementation outcomes will be barriers and facilitators of implementation, based on semi-structured interviews and focus groups. A cost minimisation analysis, using decision trees, will be evaluated as service outcomes. Client outcomes will be assessed via parent-reported transfer experience questionnaires and interviews and the clinical outcomes NICU-level III transfer rate and length of stay.

Ethics and dissemination: This study was reviewed by the Medical Ethical Committee of the Erasmus Medical Centre, who confirmed that the rules laid down in the Medical Research Involving Human Subjects Act do not apply (identification number: MEC-2023–0561). Results will be published in peer-reviewed journals in two separate scientific articles: the primary evaluation and the cost evaluation.

Development and internal validation of a clinical prediction model for the needed level of care in preterm neonates

Journal article (2025) - Josephine H.L. Wagenaar , Marte Broekhoven , Arie Franx , Maaike S. Kleinsmann , Irwin K.M. Reiss , Hendrik Rob Taal

Purpose: To address capacity problems at tertiary-level neonatal intensive care units (NICUs) within current staffing limitations, our study aims to demonstrate the feasibility of identifying very preterm neonates not in need of highly specialised, tertiary-level, NICU care. Meth ...