TY - JOUR
T1 - Complex Surgical Infants Benefit from Postdischarge Telemedicine Visits
AU - Willard, April
AU - Brown, Elizabeth
AU - Masten, Marjorie
AU - Brant, Marisa
AU - Pouppirt, Nicole
AU - Moran, Kevin
AU - Lioy, Janet
AU - Chuo, John
N1 - Funding Information:
This project was supported, in part, by a grant from the Verizon Foundation. Study data were collected and managed using REDCap electronic data capture tools hosted in the Biostatistics Division of Washington University School of Medicine. REDCap (Research Electronic Data Capture) is a secure, Web-based application designed to support data capture for research studies, providing (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for importing data from external sources.
Publisher Copyright:
© 2018 by the National Association of Neonatal Nurses.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Background: Transition from the neonatal intensive care unit (NICU) to home is challenging for caregivers of complex surgical infants. A prospective, observational cohort pilot study using telemedicine to improve transition was implemented in a quaternary level IV NICU. Purpose: (1) To assess, identify, and resolve patient care concerns in the immediate postdischarge period. (2) To improve caregiver knowledge and care practices. Design Methods: Caregivers of medically complex infants participated in telemedicine visits with neonatal providers within 1 week of discharge. Providers reviewed infant health, equipment use, and outpatient follow-up. Video was used to visualize the infant, home environment, and care practices. Caregivers completed a postvisit satisfaction survey. Results: Ninety-three visits were performed from May 2015 to March 2017. Seventy-six percent of visits were postsurgery patients. Seventy-eight postdischarge issues were identified: medication administration (13%), respiratory (19%), feeding (33%), and surgical site (35%). Fifty percent of caregivers reported that telemedicine visits prevented an additional call or visit to a clinician; 12% prompted an earlier visit (n = 93). Caregiver satisfaction rating was high. Median estimation of total mileage saved by respondents was 1755 miles. Conclusions: Postdischarge telemedicine visits with complex surgical NICU graduates identify clinical issues, provide caregivers with support, and save travel time. Advanced practice nurses are instrumental in patient recruitment, with patient visits, and in providing postdischarge continuity of care. Barriers to implementation were identified. Implication for Practice and Research: A randomized controlled study is warranted to measure the value of telemedicine visits for specific patient cohorts.
AB - Background: Transition from the neonatal intensive care unit (NICU) to home is challenging for caregivers of complex surgical infants. A prospective, observational cohort pilot study using telemedicine to improve transition was implemented in a quaternary level IV NICU. Purpose: (1) To assess, identify, and resolve patient care concerns in the immediate postdischarge period. (2) To improve caregiver knowledge and care practices. Design Methods: Caregivers of medically complex infants participated in telemedicine visits with neonatal providers within 1 week of discharge. Providers reviewed infant health, equipment use, and outpatient follow-up. Video was used to visualize the infant, home environment, and care practices. Caregivers completed a postvisit satisfaction survey. Results: Ninety-three visits were performed from May 2015 to March 2017. Seventy-six percent of visits were postsurgery patients. Seventy-eight postdischarge issues were identified: medication administration (13%), respiratory (19%), feeding (33%), and surgical site (35%). Fifty percent of caregivers reported that telemedicine visits prevented an additional call or visit to a clinician; 12% prompted an earlier visit (n = 93). Caregiver satisfaction rating was high. Median estimation of total mileage saved by respondents was 1755 miles. Conclusions: Postdischarge telemedicine visits with complex surgical NICU graduates identify clinical issues, provide caregivers with support, and save travel time. Advanced practice nurses are instrumental in patient recruitment, with patient visits, and in providing postdischarge continuity of care. Barriers to implementation were identified. Implication for Practice and Research: A randomized controlled study is warranted to measure the value of telemedicine visits for specific patient cohorts.
KW - NICU
KW - discharge
KW - follow-up
KW - healthcare utilization
KW - neonatal
KW - nurse practitioner
KW - pediatric surgery
KW - prospective cohort study
KW - telehealth
KW - telemedicine
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UR - http://www.scopus.com/inward/citedby.url?scp=85042646859&partnerID=8YFLogxK
U2 - 10.1097/ANC.0000000000000460
DO - 10.1097/ANC.0000000000000460
M3 - Article
C2 - 29373346
AN - SCOPUS:85042646859
SN - 1536-0903
VL - 18
SP - 22
EP - 30
JO - Advances in Neonatal Care
JF - Advances in Neonatal Care
IS - 1
ER -