Abstract
BackgroundThe 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.MethodsWe 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 semi-structured 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.ResultsAdoption: 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.ConclusionsThis 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.
Highlights
Children with medical complexity (CMC) are a growing population of children in the USA
Hospitalists play an important role in care for children with medical complexity (CMC), including discharge from the hospital [4]
Prior work by Solan et al described numerous problems with hospitalist-primary care provider (PCP) communication at the time of hospital discharge, including perceived devaluation of the PCP and unclear post-discharge responsibilities, and identified videoconferences as a potential solution [8]
Summary
Children with medical complexity (CMC) are a growing population of children in the USA. Prior work by Solan et al described numerous problems with hospitalist-primary care provider (PCP) communication at the time of hospital discharge, including perceived devaluation of the PCP and unclear post-discharge responsibilities, and identified videoconferences as a potential solution [8]. Multidisciplinary discharge videoconferences have been shown to improve communication, increase access to hospital staff and information, and decrease medication errors during geriatric hospital to post-acute care (2020) 6:27 transitions [9]. This approach has not been studied in children. Our objective was to evaluate implementation of a multidisciplinary discharge videoconference in order to inform future efforts to improve hospital to home transitions for CMC. Our objective was to evaluate the implementation of a discharge videoconference incorporating the patient, caregiver, primary care provider (PCP), hospitalist physician, and case manager
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