P1006 - Impact of Teleneonatology on Transfer Rates: Do birth hospital level of care and patient gestational age matter?

Background: Teleneonatology allows neonatologists to establish real-time audio-video telemedicine connections with community hospital care teams when neonates require advance resuscitation or critical care. Teleneonatology has been shown to reduce a newborn’s odds of transfer to a higher level of care (LOC) by nearly 30%. It is unknown whether the impact of teleneonatology on transfer rates is influenced by the level of neonatal care in the birth hospital (Level I well-baby nursery versus Level II special care nursery) or the gestational age (GA) of the neonate. In addition, it is unclear if the effect of teleneonatology on transfer rates is sustained over time.

Objective: The primary objective of this study was to determine whether the percent of neonates transferred to a higher LOC after a teleneonatology consult differed based on the level of neonatal care at the birth hospital (Level I versus Level II nursery) or the GA of the infant. Our secondary objective was to determine whether transfer rates after teleneonatology consultation remained stable over a 3-year period.

Methods: During the study period (10/18/2016 to 10/18/2019), teleneonatology consults were provided to 11 community hospitals in a two-state region. Community hospital practice models differed by site (Table 1). After each teleneonatology consult, standard quality assurance data was collected which included the patient’s GA, birth hospital level of neonatal care, and patient disposition (Table 1). Transfer rates were compared between nursery levels, gestational age categories, and across time periods using Poisson regression.

Results: There were 302 teleneonatology consults during the study period. Sixty-six percent (n=198) were provided to neonates in a Level II nursery and 34% (n=104) to neonates in a Level I nursery. The consult rate was significantly higher in Level I compared to Level II nurseries (consult rate 3/100 live births vs 1/100 live births, P<.001, Table 2). However the transfer rate after consultation was not significantly different between Level I and Level II nurseries, with about two-thirds of neonates transferred. Gestational age significantly impacted the transfer rate in both Level I and Level II nurseries. While about half of term infants required transfer, 65-100% of preterm infants were transferred to a higher LOC depending on the degree of prematurity. Over the three-year study period, there was no significant change in the overall transfer rate (P=.57), transfer rates among Level I nurseries (P=.33), and transfer rates among Level II nurseries (P=.95).

Conclusion: Rate of transfer to a higher LOC after teleneonatology consultation was not different between Level I and Level II nurseries. Gestational age significantly impacted transfer rate in both Level I and II nurseries, with preterm infants having the highest rate of transfer. This information is useful for organizations planning to deliver or receive teleneonatology services.