Implementation of a multidisciplinary discharge videoconference for children with medical complexity: a pilot study

Noga L Ravid; Kayla Zamora; Roberta Rehm; Megumi Okumura; John Takayama; Sunitha Kaiser

doi:10.1186/s40814-020-00572-7

Implementation of a multidisciplinary discharge videoconference for children with medical complexity: a pilot study

Pilot Feasibility Stud. 2020 Feb 18:6:27. doi: 10.1186/s40814-020-00572-7. eCollection 2020.

Authors

Noga L Ravid¹, Kayla Zamora², Roberta Rehm³, Megumi Okumura¹, John Takayama¹, Sunitha Kaiser¹

Affiliations

¹ 1Department of Pediatrics, University of California, San Francisco, 550 16th St. 5th floor, Box 0110, San Francisco, CA 94143 USA.
² 2San Francisco School of Medicine, University of California, 513 Parnassus Avenue, San Francisco, CA 94143 USA.
³ 3Department of Family Health Care Nursing, University of California at San Francisco, 2 Koret Way, San Francisco, CA 94143 USA.

Abstract

Background: The 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.

Methods: We 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.

Results: Adoption: 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.

Conclusions: This 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.

Keywords: Children with medical complexity; Hospital to home transition; Telemedicine.