The Impact of Telemedicine on Transfer Rates of Newborns at Rural Community Hospitals

Abstract Background and Objectives Telemedicine may have the ability to reduce avoidable transfers by allowing remote specialists the opportunity to more effectively assess patients during consultations. In this study, we examined whether telemedicine consultations were associated with reduced transfer rates compared to telephone consultations among a cohort of term and late preterm newborns. We hypothesized that neonatologist consultations conducted over telemedicine would result in fewer interfacility transfers than consultations conducted over telephone. Methods We collected data on all newborns who received a neonatal telemedicine or telephone consultation at six rural hospitals in northern and central California between August 2014 and June 2018. We used adjusted analyses to compare transfer rates between telemedicine and telephone cohorts. Results A total of 317 patients were included in the analysis; 89 (28.1%) of these patients received a telemedicine consultation and 228 (71.9%) received a telephone consultation only. The overall transfer rate was 77.0%. Patient consultations conducted using telemedicine were significantly less likely to result in a transfer than patient consultations conducted using the telephone (64.0% vs 82.0%, p=0.001). After controlling for 5-minute Apgar score, birthweight, gestational age, site of consultation, and transport risk index of physiologic stability (TRIPS-II) score, the odds of transfer for telemedicine consultations was 0.48 (95% CI: 0.26,0.90, p=0.02). Conclusion Our findings suggest that telemedicine may have the potential to reduce potentially avoidable transfers of term and late preterm newborns. Future research on potentially avoidable transfers and patient outcomes is needed to better understand the ways in which telemedicine affects clinical decision making.