As parents anticipate the birth of their child, their preparations are extensive – they create a birth plan, take classes, prepare the nursery and research every item their baby may need.
But few think of asking a vital question when considering where to deliver: What happens if my baby is not breathing after delivery?
With one out of 10 babies born in the U.S. needing assistance with breathing at birth, this question should be front and center. The American Academy of Pediatrics has identified a limited “golden minute” after delivery, where the baby should be breathing well or should receive artificial ventilation to prevent a tragic consequence that can range from potential brain damage to long-term disabilities such as cerebral palsy, to loss of life from asphyxia.
To date, parents don’t have a way to determine if hospitals are well-equipped to manage the golden minute, something that MedicalCue, a Fogarty Institute company-in-residence, is determined to change.
A knowledge gap, despite the training
Medical personnel, of course, are highly skilled in dealing with infant emergencies. They rely on the Neonatal Resuscitation Program (NRP), which is considered the gold standard of care in neonatal resuscitation. However, at 328 pages, the Textbook of Neonatal Resuscitation is long and complicated — even with the biannual certification required for healthcare providers, studies have shown that clinicians have only a 16 to 55 percent accuracy rate in adherence to NRP, and that knowledge degrades over time from their certification training.
Without special tools or frequent practice, NRP tends to slip away from clinicians – on average they lose knowledge of 10 percent of the material with every month that passes between trainings. While continuous training is the best weapon to fight knowledge decay, even well-funded hospitals with simulation labs costing over $100,000 must restrict staff to no more than one or two simulations per year.
When protocols are not repeated on a daily basis, there is no means to develop the mental “muscle memory” to make a process automatic. In NRP, this means dramatically reduced adherence to prescribed guidance and increased stress for the clinician.
The implementation of the NRP protocol is further complicated by the fact that clinical resuscitation teams are always changing for each resuscitation, and not all members of the team are available throughout the process. Much time is lost in coordinating and communicating between those involved.
Reinventing the company to provide guidance and support
As MedicalCue was completing studies on its first device, the NeoCue, at two hospitals, the team realized the full potential the device could have on raising and standardizing the quality of care for neonatal resuscitation. Initially intended to identify the specific NRP steps necessary for the situation, MedicalCue is broadening its scope to fill a void in the market for capturing data on the crucial first minutes of birth. The NeoCue tablet times and tracks the team’s activity and prompts them on next steps in adherence with the medical protocol. It then generates a report that can be used to measure performance and coach the team. In addition, it helps physicians prepare a more comprehensive and accurate report following the event.
Eventually the data can be used to allow individual hospitals to anonymously benchmark their performance against national metrics and establish a “leaderboard” of centers of excellence.
The startup has also developed a mobile-based app, SimCue, which can be used for training, thus improving the team’s ability to respond quickly and appropriately.
In the future, MedicalCue’s technology can be adopted to address other crisis scenarios, such as recording and training for heart attack response. The startup is currently fundraising to support these additional long-term goals.
“As we began to design what appeared to be a solution for a very specific problem, we realized that perhaps this simple tablet solution could be applied to every aspect of healthcare quality management,” said Marie Alexander, CEO of MedicalCue. “To truly achieve quality, every aspect must be considered – training, practice, delivery, recording, goal setting and measurement – at an individual, hospital and industry level. We are excited about this next step in our corporate growth and definition.”