Effects of a 1-Time Nurse-Led Telephone Call After Pediatric Discharge

Abstract

Hospital-to-Home Outcomes Trial Study Group IMPORTANCE Families often struggle after discharge of a child from the hospital. Postdischarge challenges can lead to increased use of urgent health care services.OBJECTIVE To determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success. DESIGN, SETTING, AND PARTICIPANTSThis Hospital-to-Home Outcomes (H2O) randomized clinical trial included 966 children and adolescents younger than 18 years (hereinafter referred to as children) admitted to general medicine services at a free-standing tertiary care children's hospital from May 11 through October 31, 2016. Data were analyzed as intention to treat and per protocol.INTERVENTIONS A postdischarge telephone call within 4 days of discharge compared with standard discharge. MAIN OUTCOMES AND MEASURESThe primary outcome was the 30-day reutilization rate for urgent health care services (ie, unplanned readmission, emergency department visit, or urgent care visit). Secondary outcomes included additional utilization measures, as well as parent coping, return to normalcy, and understanding of clinical warning signs measured at 14 days.RESULTS A total of 966 children were enrolled and randomized (52.3% boys; median age [interquartile range], 2.4 years [0.5-7.8 years]). Of 483 children randomized to the intervention, the nurse telephone call was completed for 442 (91.5%). Children in the intervention and control arms had similar reutilization rates for 30-day urgent health care services (intervention group, 77 [15.9%]; control group, 63 [13.1%]; P = .21). Parents of children in the intervention group recalled more clinical warning signs at 14 days (mean, 1.8 [95% CI, 1.7-2.0] in the intervention group; 1.5 [95% CI, 1.4-1.6] in the control group; ratio of intervention to control, 1.2 [95% CI, 1.1-1.3]).CONCLUSIONS AND RELEVANCE Although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, this method shows promise to bolster postdischarge education.

A Qualitative Study of Increased Pediatric Reutilization After a Postdischarge Home Nurse Visit

“…A total of 33 parents participated in the interviews (intervention/readmit [8], intervention/no readmit [8], control/readmit [8], and control/no readmit [9]). Although we selected families from all 4 categories, we were not able to explore qualitative differences between these groups because of the relatively low numbers of participants.…”

“…A second trial of the intervention adapted to a phone call also failed to decrease reutilization rates. 9 Both physician stakeholder groups perceived that the intervention directed traffic back to the hospital because of the intervention design. Coupled with the perception that the red flags may have changed a family's threshold for seeking care and/or that an RN may be more Hospital-affiliated RNs "directing traffic" back to hospital HM "The fact that the nurses were a hospital-based versus medical home-based … might have biased patients going to more expensive resources like ER versus the primary care doctor.…”

“…19 Family priorities and preferences related to preparation for discharge, including family engagement, respect for discharge readiness, and goal of returning to normal routines, may be areas on which to focus with future interventions in this population. 20 In summary, although widespread postdischarge interventions (home nurse visit 4 and nurse telephone call 9 ) have not been found to be effective, targeting interventions to specific populations by diagnosis or demographic factors may Providing context for and framing of red flags PCP "So it, I mean, because like the Barton Schmitt Nursing Guidelines, Triage Guidelines, have like good, like call 911, go to the emergency room now, be seen in the office today, be seen in the office tomorrow, today or tomorrow, eventually. … So that's kind of my mental framework for that.…”

Implementation of a multidisciplinary discharge videoconference for children with medical complexity: a pilot study

“…Our intervention differed in its inclusion of the patient and caregiver in the handoff, a practice in keeping with principles of familycentered care [22]. Two large pediatric RCTs evaluating the impact of post-discharge contact with patients and families found mixed effects on 30-day reutilization [23,24]. However, our intervention differed both in its pre-discharge timing and incorporation of the PCP, both of which, we found to have potentially broader effects, such as increasing PCP comfort.…”

Randomized controlled trial evaluating a collaborative model of care for transitioning children with medical complexity from hospital to home healthcare: Study protocol

“…Different models of comprehensive care for CMC have been evaluated in clinical trials before [ [16] , [17] , [18] ]. Post-discharge interventions in pediatrics have also been described [ [18] , [19] , [20] ]. However, studies focused on transitioning CMC from hospital to home healthcare are limited.…”