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

Abstract

Background: The hospital to home transition for children with medical complexity (CMC) poses many challenges, including suboptimal communication between the hospital and medical home. Our objective was to evaluate the implementation of a discharge videoconference incorporating the patient, caregiver, primary care provider (PCP), hospitalist physician, and case manager. Methods:We evaluated implementation of this pilot intervention at a freestanding tertiary care children's hospital using mixed methods. A discharge videoconference was conducted for hospitalized children (< 18 years old) meeting complex chronic disease (C-CD) criteria. We collected field notes and conducted surveys and semistructured interviews. Outcomes included adoption, cost, acceptability, feasibility, and appropriateness. Adoption, cost, and acceptability were analyzed using descriptive statistics. Acceptability, feasibility, and appropriateness were summarized using thematic content analysis.Results: Adoption: A total of 4 CMC (9% of the 44 eligible children) had discharge videoconferences conducted. Cost (in provider time): On average, videoconferences took 5 min to schedule and lasted 21.5 min. Acceptability: All hospitalists involved (n = 4) were very likely to participate again. Interviews with caregivers (n = 4) and PCPs (n = 5) demonstrated that for those participating, videoconferences were acceptable and appropriate due to benefits including development of a shared understanding, remote physical assessment by the PCP, transparency, and humanization of the care handoff, and increased PCP comfort with care of CMC. Feasibility: Barriers included internet connection quality and scheduling constraints. Conclusions: This novel, visual approach to discharge communication for CMC had low adoption, possibly related to recruitment strategy. The videoconference posed low time burdens, and participating physicians and caregivers found them acceptable due to a variety of benefits. We identified several feasibility barriers that could be targeted in future implementation efforts.

Impact of the Coronavirus Pandemic on Pediatric Palliative Care Team Structures, Services, and Care Delivery

“…19 Seriously ill children often live at a distance from treatment centers, warranting consideration of whether telehealth may help bridge the care or communication gap for families. [20][21][22] While telehealth uptake in pediatric palliative care had historically been slow, 23,24 this study showed that pediatric interdisciplinary teams now utilize telehealth and may have the potential to foster communication and connection through telehealth although teams are in need of additional telehealth training and quality outcome measures. The survey suggests a need to track financial vulnerabilities and sustainable care models for pediatric palliative programs.…”

“…19 The pandemic emphasizes the need for deliberate attention toward not just individual resilience but also for organizational-level resilience resources and staff support strategies. 20 Implementable approaches for promoting team resilience and workforce well-being, such as the Promoting Resilience in Stress Management at Work Program and the signposting of discipline-specific resilience initiatives, represent essential priorities. 21,22 Ideally this translates into sustainable models within hospitals and community settings for integrated support for health care workers.…”

No Place Like Home

“…There are numerous published reports describing gaps in PCPs' knowledge when it comes to caring for infants with medical complexity. 8,9,11 A common theme among PCPs is the need to develop care coordination skills and better communication between providers. Also, studies describe that community visiting nurses encounter similar challenges; parents report that these nurses are not always equipped to manage the needs of medically complex infants in the home.…”

Stakeholder perspectives: Communication, care coordination, and transitions in care for children with medical complexity

“…Nurse leaders and case managers are ideally positioned to support coordinated family centered rounds with multiple care teams. Adhering to detailed caregiver education plans, discharge coordination by unit‐based case managers, and implementing innovative approaches to handoffs between inpatient and outpatient providers could improve discharge outcomes (Ravid et al, 2020; White et al, 2017).…”