Purpose
To identify characteristics that predict successful telephone follow-up with parents of infants with severe bronchiolitis.
Methods
We analyzed data from a 17-center, prospective cohort study of infants (age <1 year) hospitalized with bronchiolitis during three consecutive fall/winter seasons. Participant contact information and clinical data were collected during the index hospitalization. Parents were called at 6-month intervals (based on the child’s age) after discharge to assess respiratory problems. The primary outcome was age 12-month telephone interview status. Participants were classified as unreachable after 28 days of unsuccessful attempts.
Results
798 of 916 children (87%) completed the age 12-month telephone interview. In unadjusted analyses, factors associated with successful follow-up included: private health insurance, annual household income ≥$60,000, and residing in the Northeast, Midwest, or West. Follow-up was less common among non-Hispanic blacks, Hispanics, and households with ≥3 children. In multivariable analyses, follow-up was more likely among parents of females, and, compared to the South, in the Northeast and Midwest (all P<0.05). Compared to non-Hispanic whites, non-Hispanic blacks and Hispanics remained less likely to complete the interview as did households with ≥3 children (all P<0.05).
Conclusion
Socio-demographic and geographic factors predict successful telephone follow-up, even among parents of infants with severe illness.
Telepresent leaders were connected via videoconference from a remote location and displayed on a screen to the bedside physician, confederate nurses, and parent. In-person leaders were present at the bedside. All teams participated in a 20 minute simulated resuscitation of a 6 month-old patient in severe septic shock who decompensates into ventricular fibrillation after eight minutes in a standardized, pre-programmed scenario. Simulations were video recorded and scored on teamwork, communication, leadership, and adherence to AHA guidelines using the STAT instrument. Immediately after each case, team members completed demographic, workload (NASA TLX), and teamwork/ communication (TeamMonitor) surveys. Confederate nurses also completed the TeamMonitor survey and assigned a global rating score. Post-simulation debriefings were scripted to collect qualitative feedback from participants regarding utility, effectiveness, and acceptability of telepresence during resuscitation.Results: Twelve of 20 teams have been enrolled to date with the expected collection period to end mid-June.Please see the Results table below.Qualitative data from debriefings highlight four strategies for the effective use of telepresence: (1) enhanced verbal communication with frequent summary/assessment huddles; (2) a single bedside provider designated as the liaison with the telepresent provider;(3) explicit role delineation; and (4) mutual trust in the clinical acumen of each provider involved. Feedback demonstrates acceptance of and comfort with a telepresent team leader.Conclusion: No significant difference was noted in teamwork/communication, team leader workload, or time to defibrillation between telepresent-and in-person-led teams. However, team member overall workload, as well as effort and anxiety, were significantly increased in the telepresence group. Qualitative data reflect strategies for the effective use of telepresence. Further analysis will be conducted after enrollment of remaining teams.
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