Nursing-led Home Visits Post-hospitalization for Children with Medical Complexity

Wells, Sarah; O’Neill, Margaret; Rogers, Jayne; Blaine, Kevin P.; Hoffman, Amy J.; McBride, Sarah; Tschudy, Megan M.; Shumskiy, Igor; Mauskar, Sangeeta; Berry, Jay G.

doi:10.1016/j.pedn.2017.03.003

Cited by 32 publications

(39 citation statements)

References 28 publications

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“…For example, authors of a single-center study concluded that CMC universally had postdischarge problems that were able to be identified and managed through nurse home visits. 29 In a large observational study, CMC discharged with home health nursing had fewer subsequent hospitalizations and 30-day readmissions compared with matched controls. 30 Similarly, authors of a meta-analysis of clinical trials used to reduce readmissions found that postdischarge home visits and phone calls were most effective.…”

Section: Discussionmentioning

confidence: 99%

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial

Coller

Klitzner²,

Lerner³

et al. 2018

Pediatrics

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Section: Discussionmentioning

confidence: 99%

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial

Coller

Klitzner²,

Lerner³

et al. 2018

Pediatrics

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“…This would be consistent with a large case-control study in which researchers observed that receipt of home nursing was associated with less postdischarge hospital use 31 and a related study revealing that medical devices comprised a large proportion of challenges identified by home nurses. 32 Lastly, clarifying relationships between device-complication encounters and measures of caregiver health literacy, skill and confidence to manage these devices would be valuable next steps.…”

Section: Discussionmentioning

confidence: 99%

Encounters From Device Complications Among Children With Medical Complexity

Nackers

Ehlenbach

Kelly

et al. 2019

Hospital Pediatrics

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A B S T R A C TOBJECTIVES: Children with medical complexity (CMC) are commonly assisted by medical devices to support essential body functions, although complications may lead to preventable emergency department (ED) and hospital use. Our objective was to identify predictors of device-complicated ED visits and hospitalizations.METHODS: This single-center retrospective cohort study included patients referred to a Pediatric Complex Care Program between April 1, 2014, and April 30, 2016, assisted by at least 1 medical device. Hospitalizations and ED visits in the year before enrollment were rated for likelihood for being due to device complications. Interrater reliability among 3 independent reviewers was assessed. Bivariate followed by multivariate logistic regression clustered by patient helped us identify associations between demographic, clinical, and device characteristics associated with device-complicated ED or hospital encounters. RESULTS:Interrater reliability was high (k 5 0.92). Among 98 CMC, device-complicated encounters represented 17% of 258 hospitalizations and 31% of 228 ED visits. Complications of 3 devices (central venous catheters, enteral tubes, and tracheostomy tubes) accounted for 13% of overall hospitalizations and 28% of overall ED visits. Central venous catheter presence (adjusted odds ratio [aOR] 3.2 [95% confidence interval (CI) 1.1-9.5]) was associated with device-complicated ED visits. Gastrojejunostomy/jejunostomy tube presence (aOR 3.3 [95% CI 1.5-7.5]) or tracheostomies with (aOR 8.1 [95% CI 2.3-28.5]) or without (aOR 4.5 [95% CI 1.7-7.5]) ventilator use was associated with device-complicated hospitalizations. Clinical variables were poor predictors of device-complicated encounters.CONCLUSIONS: Device-complicated ED visits and hospitalizations comprised a substantial proportion of total hospital and ED use. Developing interventions to prevent device complications may be a promising strategy to reduce overall CMC use.

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“…Postdischarge home nurse visits in this population have been found to be feasible and address many questions and problems, but the effect on readmission is less clear. 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.…”

Section: Rnmentioning

confidence: 99%

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

Riddle

Sherman²,

Moore

et al. 2020

J Hosp Med

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BACKGROUND: The Hospital to Home Outcomes (H2O) trial was a 2-arm, randomized controlled trial that assessed the effects of a nurse home visit after a pediatric hospital discharge. Children randomized to the intervention had higher 30-day postdischarge reutilization rates compared with those with standard discharge. We sought to understand perspectives on why postdischarge home nurse visits resulted in higher reutilization rates and to elicit suggestions on how to improve future interventions. METHODS: We sought qualitative input using focus groups and interviews from stakeholder groups: parents, primary care physicians (PCP), hospital medicine physicians, and home care registered nurses (RNs). A multidisciplinary team coded and analyzed transcripts using an inductive, iterative approach. RESULTS: Thirty-three parents participated in interviews. Three focus groups were completed with PCPs (n = 7), 2 with hospital medicine physicians (n = 12), and 2 with RNs (n = 10). Major themes in the explanation of increased reutilization included: appropriateness of patient reutilization; impact of red flags/warning sign instructions on family’s reutilization decisions; hospital-affiliated RNs “directing traffic” back to hospital; and home visit RNs had a low threshold for escalating care. Major themes for improving design of the intervention included: need for improved postdischarge communication; individualizing home visits—one size does not fit all; and providing context and framing of red flags. CONCLUSION: Stakeholders questioned whether hospital reutilization was appropriate and whether the intervention unintentionally directed patients back to the hospital. Future interventions could individualize the visit to specific needs or diagnoses, enhance postdischarge communication, and better connect patients and home nurses to primary care.

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Nursing-led Home Visits Post-hospitalization for Children with Medical Complexity

Cited by 32 publications

References 28 publications

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial

Encounters From Device Complications Among Children With Medical Complexity

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

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