Postdischarge Nurse Home Visits and Reuse: The Hospital to Home Outcomes (H2O) Trial

Auger, Katherine A.; Simmons, Jeffrey M.; Tubbs‐Cooley, Heather L.; Sucharew, Heidi; Statile, Angela; Pickler, Rita H.; Sauers‐Ford, Hadley S.; Gold, Jennifer; Beck, Andrew F.; Wade‐Murphy, Susan; Kuhnell, Pierce; Shah, Samir S.

doi:10.1542/peds.2017-3919

Cited by 43 publications

(55 citation statements)

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“…27 The results of both H2O trials have interesting similarities and differences ( Table 4). 11 The first H2O trial compared a postdischarge in-home nurse visit with standard discharge. In both trials, children randomized to the intervention groups had higher odds of unplanned 30-day use of health services than the control groups (1.33 in the first H2O trial; 1.26 in the present H2O trial).…”

Section: Discussionmentioning

confidence: 99%

“…The first Hospital-to-Home Outcomes (H2O) trial was a 2-arm RCT designed to assess the effectiveness of a 1-time, nurseled transitional home visit after hospital discharge among children who would not otherwise qualify for skilled nursing visits. 11 Prior focus group work 1 indicated that some families prefer a telephone call to an in-person visit. We recognized that telephone calls may be more feasible and scalable given the adoption in national readmission reduction work.…”

Section: Pretrial Contextmentioning

confidence: 99%

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Effects of a 1-Time Nurse-Led Telephone Call After Pediatric Discharge

et al. 2018

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Hospital-to-Home Outcomes Trial Study Group IMPORTANCE Families often struggle after discharge of a child from the hospital. Postdischarge challenges can lead to increased use of urgent health care services.OBJECTIVE To determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success. DESIGN, SETTING, AND PARTICIPANTSThis Hospital-to-Home Outcomes (H2O) randomized clinical trial included 966 children and adolescents younger than 18 years (hereinafter referred to as children) admitted to general medicine services at a free-standing tertiary care children's hospital from May 11 through October 31, 2016. Data were analyzed as intention to treat and per protocol.INTERVENTIONS A postdischarge telephone call within 4 days of discharge compared with standard discharge. MAIN OUTCOMES AND MEASURESThe primary outcome was the 30-day reutilization rate for urgent health care services (ie, unplanned readmission, emergency department visit, or urgent care visit). Secondary outcomes included additional utilization measures, as well as parent coping, return to normalcy, and understanding of clinical warning signs measured at 14 days.RESULTS A total of 966 children were enrolled and randomized (52.3% boys; median age [interquartile range], 2.4 years [0.5-7.8 years]). Of 483 children randomized to the intervention, the nurse telephone call was completed for 442 (91.5%). Children in the intervention and control arms had similar reutilization rates for 30-day urgent health care services (intervention group, 77 [15.9%]; control group, 63 [13.1%]; P = .21). Parents of children in the intervention group recalled more clinical warning signs at 14 days (mean, 1.8 [95% CI, 1.7-2.0] in the intervention group; 1.5 [95% CI, 1.4-1.6] in the control group; ratio of intervention to control, 1.2 [95% CI, 1.1-1.3]).CONCLUSIONS AND RELEVANCE Although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, this method shows promise to bolster postdischarge education.

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Section: Discussionmentioning

confidence: 99%

Section: Pretrial Contextmentioning

confidence: 99%

Effects of a 1-Time Nurse-Led Telephone Call After Pediatric Discharge

et al. 2018

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“…In 2015 and 2016 we conducted a randomized controlled trial to evaluate the effect of a single nurse home visit after standard paediatric discharge on patient‐ and family‐centred outcomes as part of the Hospital‐to‐Home Outcomes (H2O) Study (Auger et al, 2018; Tubbs‐Cooley et al, 2016; ClinicalTrials.gov Identifier: NCT02081846). The trial's primary outcome was unplanned re‐hospitalization, emergency department visit and urgent care visit in 30 days of discharge.…”

Section: The Studymentioning

confidence: 99%

Paediatric clinical and social concerns identified by home visit nurses in the immediate postdischarge period

Tubbs‐Cooley

Riddle

Gold³

et al. 2020

Journal of Advanced Nursing

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Aim:To describe paediatric postdischarge concerns manifesting in the first 96 hr after hospital discharge.Design: Analysis of nursing documentation generated as part of a randomized controlled trial evaluating the effect of a nurse home visit on healthcare re-use. Methods:We analysed home visit records of 651 children (age <18) hospitalized at a large Midwestern children's hospital in 2015 and 2016 who were enrolled in the trial.Registered nurses documented concerns in structured fields and free-text notes in visit records. Descriptive statistics were used to summarize visit documentation. Free-text visit notes were reviewed and exemplars illustrative of quantitative findings were selected. Results:Overall, nurses documented at least one concern in 56% (N = 367) of visits. Most commonly, they documented concerns about medication safety (15% or 91 visits). Specifically, in 11% (N = 58) of visits nurses were concerned that caregivers lacked a full understanding of medications and in 8% (N = 49) of visits families did not have prescribed discharge medications. Pain was documented as present in 9% of all visits (N = 56). Nurses completed referrals to other providers/services in 12% of visits (N = 78), most frequently to primary care providers. In 13% of visits (N = 85) nurses documented concerns considered beyond the immediate scope of the visit related to social needs such as housing and transportation. Conclusion: Inpatient and community nurses and physicians should be prepared toreconcile and manage discharge medications, assess families' medication administration practices and anticipate social needs after paediatric discharge. Impact: Little empirical data are available describing concerns manifesting immediately after paediatric hospital discharge.Concerns about medication safety were most frequent followed by concerns related to housing and general safety. | 1395TUBBS-COOLEY ET aL. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section.

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“…19 Family priorities and preferences related to preparation for discharge, including family engagement, respect for discharge readiness, and goal of returning to normal routines, may be areas on which to focus with future interventions in this population. 20 In summary, although widespread postdischarge interventions (home nurse visit 4 and nurse telephone call 9 ) have not been found to be effective, targeting interventions to specific populations by diagnosis or demographic factors may Providing context for and framing of red flags PCP "So it, I mean, because like the Barton Schmitt Nursing Guidelines, Triage Guidelines, have like good, like call 911, go to the emergency room now, be seen in the office today, be seen in the office tomorrow, today or tomorrow, eventually. … So that's kind of my mental framework for that.…”

Section: Rnmentioning

confidence: 99%

A Qualitative Study of Increased Pediatric Reutilization After a Postdischarge Home Nurse Visit

Riddle

Sherman²,

Moore

et al. 2020

J Hosp Med

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BACKGROUND: The Hospital to Home Outcomes (H2O) trial was a 2-arm, randomized controlled trial that assessed the effects of a nurse home visit after a pediatric hospital discharge. Children randomized to the intervention had higher 30-day postdischarge reutilization rates compared with those with standard discharge. We sought to understand perspectives on why postdischarge home nurse visits resulted in higher reutilization rates and to elicit suggestions on how to improve future interventions. METHODS: We sought qualitative input using focus groups and interviews from stakeholder groups: parents, primary care physicians (PCP), hospital medicine physicians, and home care registered nurses (RNs). A multidisciplinary team coded and analyzed transcripts using an inductive, iterative approach. RESULTS: Thirty-three parents participated in interviews. Three focus groups were completed with PCPs (n = 7), 2 with hospital medicine physicians (n = 12), and 2 with RNs (n = 10). Major themes in the explanation of increased reutilization included: appropriateness of patient reutilization; impact of red flags/warning sign instructions on family’s reutilization decisions; hospital-affiliated RNs “directing traffic” back to hospital; and home visit RNs had a low threshold for escalating care. Major themes for improving design of the intervention included: need for improved postdischarge communication; individualizing home visits—one size does not fit all; and providing context and framing of red flags. CONCLUSION: Stakeholders questioned whether hospital reutilization was appropriate and whether the intervention unintentionally directed patients back to the hospital. Future interventions could individualize the visit to specific needs or diagnoses, enhance postdischarge communication, and better connect patients and home nurses to primary care.

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Postdischarge Nurse Home Visits and Reuse: The Hospital to Home Outcomes (H2O) Trial

Abstract: Children randomly assigned to the intervention had higher rates of 30-day postdischarge unplanned health care reuse. Parents in the intervention group recalled more clinical warning signs 2 weeks after discharge.

Cited by 43 publications

References 40 publications

Effects of a 1-Time Nurse-Led Telephone Call After Pediatric Discharge

Effects of a 1-Time Nurse-Led Telephone Call After Pediatric Discharge

Paediatric clinical and social concerns identified by home visit nurses in the immediate postdischarge period

A Qualitative Study of Increased Pediatric Reutilization After a Postdischarge Home Nurse Visit

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