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.

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.

This chapter presents an approach to enhancing neonatal care through the application of artificial intelligence (AI). Utilizing network-oriented modeling methodologies, the study aims to develop a network model to improve outcomes in neonatal respiratory support. The introduction sets the stage by outlining the significance of neonatal respiratory support and the challenges faced in this domain. The literature review delves into the existing body of work, highlighting the gaps and the need for a network modeling approach. The network-oriented modeling approach provides a robust framework that captures various states, such as world states, doctors’ mental states, and AI coach states, facilitating a comprehensive understanding of the complex interactions in neonatal respiratory support. Through Matlab simulations, the study investigates multiple scenarios, from optimal conditions to deviations from standard protocol. The main contribution focuses on the introduction of an AI coach, which serves as a real-time intervention mechanism to fill in the doctor's knowledge gaps. The research serves as a seminal work in the intersection of artificial intelligence and healthcare, demonstrating the potential of network-oriented modeling in improving patient outcomes and streamlining healthcare protocols.

This chapter presents the use of second-order adaptive network models of hospital teams consisting of doctors and nurses, interacting together. A variety of scenarios are modelled and simulated, in relation with respiratory distress of a neonate, along with the integration of an AI-Coach for monitoring and support of such teams and of organizational learning. The research highlights the benefits of introducing a virtual AI-Coach in a hospital setting. The practical application setting revolves around a medical team responsible for managing neonates with respiratory distress. In this setting an AI-Coach act as an additional team member, to ensure correct execution of medical procedure. Through simulation experiments, the adaptive network models demonstrate that the AI-Coach not only aids in maintaining correct medical procedure execution but also facilitates organizational learning, leading to significant improvements in procedure adherence and error reduction during neonatal care.

This chapter describes an extension of a safety culture within hospital organizations providing more transparency and acknowledgement of all actors, and in particular the parents. It contributes a model architecture to support a hospital to develop such an extended safety culture. It is illustrated for prevention of postpartum depression. Postpartum depression is a commonly known consequence of childbirth for both mothers and fathers. In this research, we computationally analyze the risk factors and lack of support received by fathers. Therefore, we use shared mental models to model the effects of poor and additional communication by healthcare practitioners to mitigate the development of postpartum depression in both the mother and the father. Both individual mental models and shared mental models are considered in the design of the computational model. The chapter illustrates the benefits of simple support for communication during childbirth, which has lasting effects, even outside the hospital. For the impact of additional communication, a Virtual Safety Coach is designed that intervenes when necessary to provide support, i.e., when a health care practitioner doesn’t. Moreover, organizational learning is also modelled to improve the mental models of both the Safety Coach and the Health Care Practitioner.

This article presents the use of second-order adaptive network models of hospital teams consisting of doctors and nurses, interacting together. A variety of scenarios are modelled and simulated, in relation with respiratory distress of a neonate, along with the integration of an AI-Coach for monitoring and support of such teams and of organizational learning. The research highlights the benefits of introducing a virtual AI-Coach in a hospital setting. The practical application setting revolves around a medical team responsible for managing neonates with respiratory distress. In this setting an AI-Coach act as an additional team member, to ensure correct execution of medical procedure. Through simulation experiments, the adaptive network models demonstrate that the AI-Coach not only aids in maintaining correct medical procedure execution but also facilitates organizational learning, leading to significant improvements in procedure adherence and error reduction during neonatal care.

Previous reports show that a substantial proportion of (near) medical errors in the operating theatre is attributable to ineffective communication between healthcare professionals. Speaking up about observed medical errors is a safety behaviour which promotes effective communication between health care professionals, consequently optimising patient care by reducing medical error risk. Speaking up by health care professionals (e.g., nurses, residents) remains difficult to execute in practice despite increasing awareness of its importance. Therefore, this chapter introduces a computational model concerning the mechanisms known from psychological, observational, and medical literature which underlie the speaking up behaviour of a health care professional. It also addresses how a doctor may respond to the communicated message. Through several scenarios, we illustrate what pattern of factors causes a healthcare professional to speak up when witnessing a (near) medical error. We moreover demonstrate how introducing an observant agent can facilitate effective communication and helps to ensure patient safety through speaking up when a nurse can not. In conclusion, the current chapter introduces a computational model which predicts speaking up behaviour from the perspective of the speaker and receiver, with the addition of a virtual coach to further optimise patient safety when a patient could be in harm's way.

This paper describes an extension of a safety culture within hospital organizations providing more transparency and acknowledgement of all actors, and in particular the parents. It contributes a model architecture to support a hospital to develop such an extended safety culture. It is illustrated for prevention of postpartum depression. Postpartum depression is a commonly known consequence of childbirth for both mothers and fathers. In this research, we computationally analyze the risk factors and lack of support received by fathers. Therefore, we use shared mental models to model the effects of poor and additional communication by healthcare practitioners to mitigate the development of postpartum depression in both the mother and the father. Both individual mental models and shared mental models are considered in the design of the computational model. The paper illustrates the benefits of simple support in terms of communication during childbirth, which has lasting effects, even outside the hospital. For the impact of additional communication, a Virtual Safety Coach is designed that intervenes when necessary to provide support, i.e., when a health care practitioner doesn't. Moreover, organizational learning is also modelled to improve the mental models of both the Safety Coach and the Health Care Practitioner.

Previous reports show that a substantial proportion of (near) medical errors in the operating theatre is attributable to ineffective communication between healthcare professionals. Speaking up about observed medical errors is a safety behaviour which promotes effective communication between health care professionals, consequently optimising patient care by reducing medical error risk. Speaking up by healthcare professionals (e.g., nurses, residents) remains difficult to execute in practice despite increasing awareness of its importance. Therefore, this paper discourses a computational model concerning the mechanisms known from psychological, observational, and medical literature which underlie the speaking up behaviour of a health care professional. It also addresses how a doctor may respond to the communicated message. Through several scenarios we illustrate what pattern of factors causes a healthcare professional to speak up when witnessing a (near) medical error. We moreover demonstrate how introducing an observant agent can facilitate effective communication and help to ensure patient safety through speaking up when a nurse can not. In conclusion, the current paper introduces an adaptive computational model which predicts speaking up behaviour from the perspective of the speaker and receiver, with the addition of a virtual coach to further optimise patient safety when a patient could be in harm's way.