Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Growing Children's Minnesota's neonatal virtual care program, with Dr. Bergeron

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Growing Children's Minnesota's neonatal virtual care program, with Dr. Bergeron · Becker’s Healthcare -- Pediatric Leadership Podcast

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  This is the Becker's Healthcare Podcast,
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  Thanks for listening. Now here's the episode.
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  This is Chris Sosa with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr. Mark Bergeron,
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  medical director for digital health transformation,
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  and medical director for the neonatal virtual care program at Children's
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  Minnesota. Dr. Bergon, thank you so much for joining us today.
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  Yeah, thanks for having me. I appreciate it.
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  Could you please introduce yourself and tell us a bit about your background?
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  Absolutely. So, uh, like you said, I, my name is Mark Bergeron.
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  I'm a practicing neonatologist at Children's Minnesota,
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  and then I wear the dual hats as medical director for digital health
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  transformation, um, for our entire healthcare system. But then, uh,
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  in the neonatology department,
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  I am medical director for our neonatal virtual care program.
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  Excellent. Could you please outline that virtual care program,
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  including how it increases access to particular critical care patients in rural
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  and regional hospitals and communities?
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  Yes, absolutely. First, just a little bit about Children's Minnesota, um,
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  and specifically our neonatology program. Um, we are truly a,
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  a regional resource for families throughout, um, the upper Midwest.
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  Um, we have a team that's 500 doctors, surgeons, nurse practitioners,
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  rehab specialists, you name it. And then, uh,
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  based both on the size of our team and the volume of patients that we take care
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  of. We're one of the largest neonatal programs, uh, in the country.
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  And certainly we are in Minnesota. Um,
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  we take care of more than 3000 babies a year, and so we do this a lot. Um,
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  our virtual care program, gosh,
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  started back in 2018 as a pilot with one of our rural hospitals, um,
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  that sends us a fair number of babies and they had a, a need, um,
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  for kind of a virtual partnership for stabilizing babies.
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  They had a single pediatrician who was concerned being fresh outta practice,
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  that, uh, he, uh,
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  was gonna find himself in a situation he'll always have at the middle of the
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  night where he was gonna want some kind of expert backup. Uh,
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  and so we approached us about, uh, could we do a virtual care program? Um,
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  and we said, yes, absolutely.
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  And so we went through the process of designing the program with his hospital
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  and, uh, did a year long pilot.
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  And the program today is much larger than that,
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  but looks exactly the same as it did as in design as it did back then.
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  Um, and basically, you know,
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  a a provider in a rural setting recognizes that he is got a baby in front of him
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  that needs critical care, um,
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  and we are there in a virtual sense in the room to walk that provider
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  through the initial steps of, uh, preparation for resuscitation,
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  the actual act of resuscitation, and then, you know,
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  streamlining that process of moving that baby from the rural setting
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  into the twin cities to our, one of our ICUs if needed. Um,
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  and doing that in a kind of a streamlined fashion.
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  Dr. Bergon,
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  how has the program evolved since it launched to serve patients throughout the
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  upper Midwest? So.
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  When we launched the program in 2018,
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  we designed it with a single site as a pilot, and, um,
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  really we designed it with a local pediatrician, uh,
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  asking for virtual care services to support him in his practice because he was
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  concerned that he would run into a situation that he pot, uh,
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  potentially wasn't, uh, comfortable managing particularly, uh, uh,
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  in a rural hospital. It doesn't have as many resources as a, as a, um,
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  large pediatric medical center would. Um,
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  so in that first year with that one site, we did 10 consults. Um,
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  and then throughout the year, up to present day,
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  we've added about two to three new hospital, uh, partners, uh, each year.
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  So now we're doing about 80, uh, consults a year.
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  We'll probably surpass that this year just because we've added, um,
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  additional sites. So we're up to 14 sites, um, as a, you know,
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  as of today and then probably two to three more, uh,
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  hospitals will get partnered with us by the end of the year.
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  I'm glad you mentioned the size of the program and how it's growing. Well,
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  how do you see the need for services like this growing as hospitals find it
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  increasingly difficult to recruit providers with unilateral experience?
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  Yeah, so as Becker's and many others have reported, um,
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  in the last year or so,
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  recruitment and retention for all types of professions in healthcare is,
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  um, is problematic. Within pediatrics, it's no different,
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  and it seems it's in the specialized field of neonatology. Um,
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  there is a definite need for neonatal expertise the further you get away
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  from a major metropolitan area. I see the need growing.
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  The way medical education works now in the United States, uh,
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  is different than it was 20 years ago when I went through training.
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  You did repeated months of training as a resident in the N I C U,
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  and that has been whittled down to, you know, just a few weeks, um, for most,
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  uh, residency programs.
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  So we have recent graduates that are coming out with not a lot of
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  confidence in being able to resuscitate,
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  resuscitate a newborn that they might have coming out of a training program,
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  you know, 10 or 20 years ago.
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  And I see that's where the role of our program really comes, uh, into, uh,
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  its importance that we can go to these regional sites and say, Hey,
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  we recognize there's gonna be some times where you need a neonatal expert, uh,
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  virtually, um, to back up the skills that your onsite provider has.
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  And we're ready to do that at a moment's notice.
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  And that's really been the success and the experience of our program,
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  is that we build these relationships with these rural providers and make them
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  feel more confident in what they can accomplish and stabilizing an infant.
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  Certainly those stabilizations and the resuscitations that you just mentioned
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  are key. There's the cornerstone to this program.
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  What else do you think about this program helps streamline transfers from the
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  hospital to the N ICUs.
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  So it used to be that you would, you know,
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  you'd be talking on the phone about the baby that's, that you can't see,
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  and you'd be relying very heavily on the,
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  the experience and the perceptions of the provider that's on site,
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  and that's variable depending on their comfort level, uh,
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  and experience with an infant. Today I see the infant at the same time they do,
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  and I have a, uh, my experience and that, and my partners,
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  we have an earlier recognition of an infant that probably needs to come to us
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  rather than having the situation described to us.
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  We see it and we recognize and we should probably mobilize our transport team
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  now. Um, and so first of all, it's that earlier recognition,
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  and then once our transport team gets on site,
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  I can describe to them in the moments before they arrive and,
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  and while they're on route,
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  here's what's going on in that delivery room or in that newborn nursery,
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  this is the status of the infant, here's what the chest x-ray looks like.
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  I've seen all the, the first labs and everything,
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  and so it was like I was in the room for them so that when they arrive,
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  there's not as many surprises and they're pretty well informed about what,
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  what they're going into, what, what type of baby they're picking up.
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  And so I would say that the accuracy of the transfer of information, uh,
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  and the timeliness of the transfer of the patient are really what's changed with
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  this technology.
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  Dr. Bergon,
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  another thing I would like to ask you is what do our listeners in the
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  neonatology space need to know about the effective programs like this?
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  In addition,
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  how can it build bridges to rural and regional hospitals within their
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  communities?
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  Well,
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  our experience has been that it's really tightened the referral relationships
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  between those partner hospitals and our, our center.
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  So we've always been a great resource to the hospitals that are distant to us.
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  Um,
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  they could always pick up the phone day or night and ask us a question about a
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  baby, describe a situation, and know that we're gonna give them, uh,
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  great information and guidance, transfer the baby when necessary. Um,
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  with this technology, I would tell your listeners,
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  it enables us to virtually be in the room and make the decisions with them in
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  real time with much, much better understanding of what the situation is.
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  Just because our eyes,
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  the eyes of our neonatal experts is on the patient and we're giving good
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  guidance, um,
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  and that guidance is better informed just by the experience of seeing and
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  hearing the activity in the room. Um,
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  I think your listeners would appreciate, uh, that
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  much of the work goes into this program through simulation before the
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  partner sites would go live.
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  And so there's an incredible amount of team building that goes. Our,
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  our simulation days is all day. We hit all shifts. And so our team,
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  uh, gets to build, uh, a nice, uh,
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  kind of team sense of, um, you know, management with these,
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  uh, simulated situations so that, you know, when we actually do it in real life,
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  it's more, uh, high functioning because we've simulated the situations.
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  Instead of just knowing the doctor's name and voice over the phone,
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  we actually know them now across a, a camera and we can recognize their face,
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  they see us, we see them, it's a much more, um, you know,
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  team feeling and they feel more, um, you know,
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  bound to us as a, a referral system, um,
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  for their high acuity needs. So it's a great two-way relationship, um,
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  strengthened by a program like this.
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  Dr. Bergon, lastly,
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  where do you see this program ending up five years from now, 10 years from now,
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  however far in the future you would like to project?
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  So kind of future state, obviously a bigger network.
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  We always want to add more partners. Um, and then kind of the,
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  the types of patients that we take care of. It's, uh, it's inception.
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  We were looking at those babies that had never left the hospital before.
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  Really those, you know, deliver room management, uh, situations.
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  Um, we've expanded in the last year to any infant up to a month of age.
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  So the neonatal service now extends into anywhere where a newborn might present
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  itself. So that includes like the emergency department coming in.
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  They can now get us, uh, uh, virtually, uh,
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  involved in a consult in the ed, for instance. Uh,
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  we'll grow the program next year to go take care of all critically ill children
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  in our partner sites, and we'll add that service, uh, gradually,
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  and that will partner with our pediatric critical care specialists,
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  so it won't be just a neonatal program anymore. Um, and then, you know,
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  that's, this is all on the front end, uh,
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  a patient that as they enter the healthcare system, um,
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  I think the opportunity to look at virtual care for neonatology, uh,
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  like daily rounding in rural hospitals that don't have neonatology coverage is
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  something that, you know, we will look at in the future. Post nicu,
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  discharge care, um, rounding in the home.
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  Those are all things that we're very interested in exploring. Um,
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  and we do a little bit of, um,
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  a program with early discharge for very healthy preterm infants leaving our
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  nursery that maybe, uh,
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  aren't fully orally feeding yet and have a feeding tube in,
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  and we're managing them at home day, doing virtual rounds daily, um,
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  for a select number of patients.
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  And I think that's what the future looks like with virtual care in neonatology.
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  Dr. Baron all sounds very exciting and it's very impressive how this program has
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  grown in seemingly such a short time.
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  Thank you so much for sharing your insights today,
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  and I look forward to connecting with you soon.
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  Hey, thanks for the opportunity. It was great to talk to you today.
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