195 - Enhancing Neonatal Care Closer to Home: Impact of Telehealth Consults on Triage and Transport Patterns in a Regional Network

Publication Number: 4192.195

Michelle Mejia, Seattle Children's, Shoreline, WA, United States; Megan M. Gray, University of Washington School of Medicine, Seattle, WA, United States; Mark Lo, University of Washington School of Medicine, Seattle, WA, United States; Rachel A.. Umoren, University of Washington, Seattle, WA, United States

Background: Telehealth is a critical tool for improving access to high-quality neonatal care in semi-urban and rural NICUs, where neonatologist coverage is often limited. It has demonstrated value in guiding transport triage and enhancing pre-transport stabilization.

Objective: To evaluate whether telehealth consults influence the frequency and variability of neonatal transport across a regional NICU network. Secondarily, we assessed the likelihood of patients remaining at their birth hospital or being transported to a community Level III NICU versus a tertiary Level IV NICU.

Design/Methods: Seattle Children's Level IV NICU implemented a telehealth service to support regional NICUs, including consults at the time of transport center contact. This facilitated collaborative decision-making, procedural guidance, and continuity of care. Transfer center encounter data from Q4 2020 to Q2 2025 were analyzed using SPC methods. XmR charts evaluated transport volume and variability; p-charts assessed proportions of transports from Level II to Level III vs. Level IV NICUs. Encounters were stratified by presence or absence of telehealth consults. Chi-square tests and odds ratios were used for statistical comparisons.

Results: 313 transfer center encounters from three Level II NICUs were analyzed. Mean quarterly interfacility transports remained stable pre- and post-telehealth implementation (13.8 vs. 15.1; NS). However, quarter-to-quarter variability increased (mR chart centerline rose from 3.3 to 5.5), suggesting more individualized triage. Post-telehealth, transfers to Level III NICUs increased (CL 37.6%, UCL 71.9%; NS), and Level IV transfers decreased (CL 55.8%, LCL 20.6%; NS). Patients with a telehealth consult at the time of transport center contact, were more likely to remain at their birth hospital or be transferred to a Level III NICU (31.9%) than those without (11.9%). Telehealth consults were associated with 3.2 times higher odds of staying at the birth hospital (95% CI: 1.03-9.96; p = 0.035) and 1.88 times higher odds of transfer to a Level III NICU (95% CI: 1.16-3.05; p = 0.01).

Conclusion(s): Telehealth did not significantly change overall transport volume but increased variability in transport decisions, reflecting more individualized triage. Patients with telehealth consults had higher odds of remaining locally or being transported to Level III NICUs. Overall, interfacility transports to the Level IV NICU decreased post-implementation. These findings support telehealth as a valuable tool in neonatal transport triage and decision-making, promoting appropriate local care and optimizing resource utilization.

Figure 1A & 1B. XmR Charts Showing Quarterly Total Transports: X Chart (A) and mR Chart (B)
A. Total transports per quarter, average transport volume did not vary significantly from pre-implementation (Q4 2020) to when all three regional sites were participating (Q1 2022), CL 13.8 vs CL 15.1, respectively. Suggesting no change to the total volume of transports. B. Transport variability was seen with the implementation of telehealth consults, average range in between values increased from 3.3 (pre-implementation) to 5.5 (post-implementation). This increased variability suggests more individualized decision-making within triaging of neonatal transports.

Figure 2A & 2B. p-Charts Showing Quarterly Proportion of Transports to Level III NICUs (A) and Level IV NICUs (B)
A. The average percentage per quarter of transports directed to community level III NICUs increased, from pre-implementation (Q4 2020) to when all three regional sites were participating (Q1 2022), CL 19.4% vs CL 37.6%. This change appears to be steady with no unstable points or trends identified within the data. B. The average percentage per quarter of transports directed to tertiary level IV NICUs decreased, from pre-implementation (Q4 2020) to when all three regional sites were participating (Q1 2022), CL 76.4% vs CL 55.8%. This change appears to be steady with no unstable points or trends identified within the data.

Figure 3A & 3B. p-Charts Showing Percentage of Patients Staying Local With and Without Consult at Time of Transport Center Contact
(A) The average quarterly percentage of patients staying locally with a consult increased from pre-implementation (Q4 2020) to full program participation (Q1 2022), from CL 4.2% (UCL 20.8%) to CL 31.9% (UCL 64.8%). This represents a significant and stable process change, as the new centerline exceeds the previous upper control limit with no unstable points or trends.
(B) The average quarterly percentage of patients staying locally without a consult decreased from CL 19.4% pre-implementation to CL 11.9% post-implementation. This suggests that improved retention is driven by program engagement rather than implementation alone. Overall, local retention with consults (31.9%) exceeds pre-telehealth retention (19.4%).