Implementation and effectiveness of Teleneonatology for neonatal intensive care unit consultations in the Netherlands
a hybrid type III implementation pilot
Josephine H.L. Wagenaar (TU Delft - DesIgning Value in Ecosystems, Erasmus Medical Center Sophia Children’s Hospital )
Julia Broos (Student TU Delft)
Ron H.T. van Beek (Amphia Hospital)
Henrike Pas ( Erasmus Medical Center Sophia Children’s Hospital )
Martijn Suurveld ( Erasmus Medical Center Sophia Children’s Hospital )
Anne Jacobs (Amphia Hospital)
Fredrik Bodell (TU Delft - DesIgning Value in Ecosystems)
Sylvia A. Obermann-Borst (Care4Neo)
Florian Cassel ( Erasmus Medical Center Sophia Children’s Hospital )
Maaike S. Kleinsmann (TU Delft - DesIgning Value in Ecosystems)
Saba Hinrichs-Krapels (TU Delft - Policy Analysis)
Irwin K.M. Reiss ( Erasmus Medical Center Sophia Children’s Hospital , University Medical Center Hamburg-Eppendorf)
H. Rob Taal ( Erasmus Medical Center Sophia Children’s Hospital )
More Info
expand_more
Other than for strictly personal use, it is not permitted to download, forward or distribute the text or part of it, without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license such as Creative Commons.
Abstract
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.
help_outline