Abstract
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.
Original language | English (US) |
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Pages (from-to) | 22-30 |
Number of pages | 9 |
Journal | Advances in Neonatal Care |
Volume | 18 |
Issue number | 1 |
DOIs | |
State | Published - Feb 1 2018 |
Funding
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.
Keywords
- NICU
- discharge
- follow-up
- healthcare utilization
- neonatal
- nurse practitioner
- pediatric surgery
- prospective cohort study
- telehealth
- telemedicine
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health