Challenges Following Hospital Discharge for Children With Medical Complexity

Abstract

The transition from hospital to home is a period of risk, particularly for children with medical complexity. Our aim was to identify and address discharge challenges through execution of postdischarge phone calls. METHODS:In this prospective study, we designed and executed a postdischarge phone call for patients discharged from an inpatient complex care team between May and November 2018. The call included dichotomous and open-ended questions to identify challenges regarding health status, follow-up appointments, medications, home nursing, medical supplies and/or equipment, and discharge instructions. These were recorded in the electronic health record. Details regarding identified challenges and corrective actions were categorized by 2 reviewers and adjudicated by a third reviewer if disagreement occurred.RESULTS: Descriptive statistics were used to summarize these findings. Sixty-seven phone calls were completed within 1 week of discharge. Two-thirds of calls identified at least 1 challenge, and more than one-third of calls identified 2 or more challenges for a total of 90 challenges. The most common challenges involved health status (26.7%), follow-up appointments (21.1%), and medications (20%). The majority of challenges were addressed by either caregivers or the multidisciplinary team, with the exception of home nursing challenges.CONCLUSIONS: Discharge challenges were commonly identified by caregivers of children with medical complexity. The majority of postdischarge challenges were addressed, with some addressed by families themselves. These results can inform health care providers about challenges to anticipate and suggest future interventions to mitigate anticipated challenges for a safe discharge and transition of care for these at-risk patients.

Garnering effective telehealth to help optimize multidisciplinary team engagement (GET2HOME) for children with medical complexity: Protocol for a pragmatic randomized control trial

“…We define medical complexity using the existing, validated Pediatric Medical Complexity Algorithm (PMCA) 31 . Patients will be eligible if they are categorized as category 3 on the PMCA tool, defined as having a complex chronic disease as they have particularly high reutilization rates 14,31 …”

“…31 Patients will be eligible if they are categorized as category 3 on the PMCA tool, defined as having a complex chronic disease as they have particularly high reutilization rates. 14,31 We will exclude patients who live independently without a parent or guardian in the home, patients who live in skilled nursing facilities, patients in the custody of the county, patients who are admitted for suicidal and homicidal ideations, and patients who are hospitalized for end-of-life care. Our rationale for these exclusions is that we are unable to reliably collect family outcomes in these scenarios.…”

“…The involvement of multiple steps, communications, and resources during this time leaves many opportunities for errors and failures that threaten safe and optimal care after discharge. Common failures during hospital‐to‐home transitions include difficulty obtaining or adequately understanding appropriate use of medications, technology and equipment, financial concerns related to care, and confusion about which care providers should be called for needs following hospitalization 14,15 . These process failures are common, even in systems with multidisciplinary, expert complex care inpatient and outpatient teams.…”

“…These process failures are common, even in systems with multidisciplinary, expert complex care inpatient and outpatient teams. One large pediatric center reported that 100% of families had one or more care gaps upon transition from hospital to home 14,15 . Additionally, many children, including some CMC, are not at their baseline health at the time of discharge 16,17 ; this poses the risk of uncertainty and misunderstanding of families and outpatient providers of where CMC are in their illness course and what care is necessary during ongoing recovery.…”

“…Common failures during hospital-tohome transitions include difficulty obtaining or adequately understanding appropriate use of medications, technology and equipment, financial concerns related to care, and confusion about which care providers should be called for needs following hospitalization. 14,15 These process failures are common, even in systems with multidisciplinary, expert complex care inpatient and outpatient teams. One large pediatric center reported that 100% of families had one or more care gaps upon transition from hospital to home.…”