Abstract
BackgroundChildren with medical complexity are a small yet resource intensive population in the Canadian health care system. The process for discharging these children from hospital to home is not yet optimal. The overall goal of this project was to develop recommendations to be included in a provincial strategy to support transitions in care for children with complex and medically fragile needs.MethodsA wide assortment of stakeholders participated in this mixed method, multiphase project. During Phase 1, data was gathered from a range of sources to document families’ experiences transitioning from an inpatient hospital stay back to their home communities. In Phase 2, pediatricians, nurses, and health administrators participated in key stakeholder interviews to identify barriers and facilitators to a successful transition in care for children and families with complex care needs. A multi-sector consensus meeting was held during Phase 3 to discuss study findings and refine key recommendations for inclusion in a provincial strategy.ResultsSix case studies were developed involving children and families discharged home with a variety of complex care needs. Children ranged in age from 15 days to 9 years old. Nine telephone interviews were conducted in Phase 2 with pediatricians, nurses, and administrators from across the province. A variety of inter-institutional communication challenges were described as a major barrier to the transition process. A consistent message across all interviews was the need for improved coordination to facilitate transitions in care. The consensus meeting to review study findings included physicians, nurses, paramedics, senior administrators, and policy analysts from different health and government sectors and resulted in six recommendations for inclusion in a provincial strategy.ConclusionsThis project identified policy and practice gaps that currently exist related to transitions in care for children with complex and medically fragile needs and their families. Our collaborative patient-centred approach to understanding how children and families currently navigate transitions in care provided a foundation for developing recommendations for a provincial wide strategy.
Highlights
Children with medical complexity are a small yet resource intensive population in the Canadian health care system
Children with complex and medically fragile needs are a small yet resource intensive population within the Canadian pediatric health care system [1, 2]. While these children represent less than 1% of the pediatric population, it is estimated they account for one third of pediatric health care spending [2]
With as many as 89% of children with complex chronic conditions being discharged from hospitalized settings [11], a well-coordinated and comprehensive transition from hospital to home is essential for improved patient and family outcomes and efficient use of health care resources
Summary
Children with medical complexity are a small yet resource intensive population in the Canadian health care system. As many as 13 physicians from 6 distinct medical specialities and numerous other care team members across the health, educational, and community settings may be involved in the care of these children and families This sizable care team extending across multiple services and sectors creates the potential for gaps in care coordination and communication [2]. In addition to these factors, their care needs may include dependence on medical technology at discharge (i.e. ventilator, feeding tubes, etc.), requiring adequate support in their home community which can place this vulnerable population at an even greater risk for adverse outcomes or hospital re-admissions, in geographically dispersed communities [2, 8, 12, 13]. Current health care structures in North American are not designed to effectively support these principles of care [17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
