As a neonatal-perinatal fellow, I quickly learned that my expertise and ability to help infants extended well beyond the physical walls of OHSU Doerbecher Children’s Hospital.
Hospitals from throughout Oregon and Southern Washington would call to ask a question about a patient, or when they had infants too sick to be cared for locally. Initially, these calls came over the phone. I realized how difficult medicine was when I wasn’t able to see the patient. Instead, I was relying on the physical exam and vital signs assessment done by other providers.
I learned creative ways to ask how a child appeared in an attempt to get a picture of that child, how critically ill he or she might be, and to help better direct the care and start the treatment plan before the child even arrived Portland.
Early in my fellowship, we began our telemedicine program in the neonatal intensive care unit. Telemedicine’s two-way, audio-video technology allows us to visually and verbally connect with a hospital outside of Portland and to see and communicate with physicians and patients.
I remember getting a phone call about an infant who was sick and needed to come to Portland. The baby needed to have a special type of IV, called an umbilical vein catheter, or UVC. OHSU Doernbecher’s PANDA transport team, which is well versed in UVCs, wouldn’t arrive for more than an hour. I recall asking the referring provider if she had ever placed a UVC. “It has been awhile,” she replied. I quickly connected to her telemedicine robot from my computer. It was as if I was instantly transported to Mid-Columbia Medical Center in The Dalles.
I easily communicated with the staff, who were amazing. Step-by-step, I walked the provider through placement of the UVC. I remember starting to use my hands a few times. I felt like I was so close to the baby that I just wanted to reach out and assist with the procedure.
Instead, I had to use my words to guide the physician in The Dalles through the steps. Thanks to the telemedicine robot, I was able to zoom in on the infant’s umbilical cord when the on-site provider had a question, and confirm the UVC was placed correctly. By the time the transport team arrived, the infant had the much-needed umbilical line in place and was ready to be transported to Portland as quickly as possible.
I have no doubt that the ability to use the telemedicine robot to guide placement of the UVC saved valuable time for the infant and instilled confidence in the local team. I know that the provider would not have felt comfortable attempting the procedure without the minute-by-minute guidance and oversight that the telemedicine robot allowed me to provide.
A Picture is Worth a Thousand Words
Each time I use telemedicine, I’m amazed at how much this quote rings true. I have used telemedicine in many situations to assess whether an infant needed to be transported to Portland, to diagnose a rash, to help a baby breathe immediately after birth, and to help a provider with a specific procedure. The sky is truly the limit with this technology, and I won’t be surprised if in the future we are able to use robot “hands” to actually assist with a procedure remotely. Until then, I am fortunate that, with the click of a button, I can see and communicate directly with critically ill babies and their providers, even when they are on the other end of the state.