Abstract
Purpose Remote screening for retinopathy of prematurity by wide-field digital imaging and network telemedicine is increasingly used to prevent blindness without the unnecessary transport of infants. Our purpose was to train and license dedicated neonatal transport nurses to do this in Hungary. Materials and methods We developed a complex, four-step curriculum in mobile retinotelemetry. Using a robust selection process, we invited eight transport nurses (NtNP/RtN) to receive training during the 2008–2017 project. The curriculum started with the basics of ophthalmology. Using an artificial eye, it continued with the theory and practice of ophthalmologic exams. Then, supervised by an ophthalmologist, each nurse performed 50 video recordings of anaesthetized and non-anaesthetized infants. Results After demonstrating their competence, five of the eight candidate nurses received a license for retinotelemetry. During their subsequent practice, they had to undergo case reviews half-yearly by a specialist and renew their license every 2–3 years. During the 2008–2016 period, we analysed 7,177 remote screenings from a training perspective. During January 1–August 31 in 2017 period, we analysed extra data from 795 remote screenings of 332 infants from specific prevention perspectives. Conclusions With the cooperation of preexisting neonatal transport service and the ophthalmological reading centre of a university hospital, a mobile telemedicine screening network was successfully developed in Hungary. Our results demonstrate how retinotelemetry can support different levels of prevention medicine. The network should work effectively and efficiently with continuous professional development.
Highlights
Retinopathy of prematurity (ROP) is one of the most frequent causes of blindness in infants
A: In 2009, after the mobile wide-field digital imaging (WFDI) system (RetCamShuttle, Clarity USA) was installed in the multifunction neonatal ambulance van, the ROP specialist and the neonatal transport nurse practitioners (NtNP) were driven to the location of the infants, and the specialist personally performed the exams in nearby neonatal intensive care unit (NICU) with the WFDI system and the assistance of the NtNP-PCA
Remarks. – For the Introduction Phase: Out of 628 examinations performed by the ROP specialist, with assistance from the NtNP-PCA, 144 were performed in peripheral hospitals and 484 in nearby NICUs
Summary
Retinopathy of prematurity (ROP) is one of the most frequent causes of blindness in infants. The use a web-based WFDI telemedicine system allows the bedside screening of premature infants inside their incubators without transportation to the ophthalmologic centre and saves the ROP specialist from going to the NICU. – Basic scientific knowledge of using the noninvasive bedside mobile WFDI system (painlessand-safe interventions, video recording, image selection/reduction, picture transportation, backing up files, and documentation),. – Capability for error-searching of system failures, – Basic scientific knowledge of how they could communicate/interpret data for NICU staff and parents, without interfering with the patient rights, C: Theoretical and practical exams based on the five blocks of the curriculum. A: NtNP-PCAs who passed the exams successfully took part in eye operations at the Department of Ophthalmology weekly They took video recordings before and after the operations, of premature babies. The ROP specialist of the PERP awarded them a license, with which they are allowed to carry out the non-invasive screening independently, on the basis of the strict PERP protocols (preparations, screening itself, selection, cutting and sending pictures, data processing, documentation, hygienic tasks and communications, etc.)
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