Highlights
- •Transition from the neonatal intensive care unit (NICU) to home is challenging
- •A nurse-led telehealth intervention, Baby Steps, addresses this gap
- •Within the first 18 months of the program, 378 infants were enrolled
- •Caregivers indicated high satisfaction and high likelihood to act on nursing advice
- •Readmissions and unplanned emergency care use were significantly decreased
Abstract
Purpose
The purpose of this nurse-led telehealth intervention was to support caregivers and
infants during the difficult period of transition from the neonatal intensive care
unit (NICU) to home.
Methods
The Baby Steps project was designed using quality improvement methodology, and was implemented in
April 2020 at a stand-alone pediatric institution in South Florida. Using a nurse-led
telehealth model, follow-up nursing care was provided in the home setting for two
weeks after discharge. Any infant cared for in the NICU and discharged to a home setting
in the state of Florida was eligible for services. Encounters included assessment,
anticipatory guidance, connection with community resources, and general support. Caregiver
satisfaction, unplanned emergency care use, and 30-day readmissions were assessed.
Results
Within the first 18 months of the program, a total of 378 infants were enrolled, and
74.6% received follow-up services in the home setting (n = 282). Caregivers reported high satisfaction with the program (100% strongly agree
or agree). There was a 46% decrease in 30-day readmissions from baseline rates, and
a substantial decrease in use of emergency care services within a month of discharge
as compared to infants discharged during the same time period who did not receive
services (30.9% vs.13.8%).
Discussion
This nurse-led intervention was found to be a feasible and highly satisfactory approach
to improve NICU patient outcomes and support caregivers during transition from hospital
to home.
Practice implications
Nurses can provide post-discharge telehealth support, which not only improves caregiver
satisfaction but also decreases readmissions and emergency care use among NICU patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric Nursing: Nursing Care of Children and FamiliesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Coaching approaches in early intervention and paediatric rehabilitation.Developmental Medicine and Child Neurology. 2020; 62: 569-574
- Telehealth nursing practice.
- Impact of social determinants and digital literacy on telehealth acceptance for pediatric cardiology care delivery during the early phase of the covid-19 pandemic.Journal of Pediatrics. 2021; 237: 115-124.e2
- Perceived maternal parenting self-efficacy (PMP S-E) tool: Development and validation with mothers of hospitalized preterm neonates.Journal of Advanced Nursing. 2007; 60: 550-560
- Rapid implementation of telerehabilitation for pediatric patients during COVID-19.International Journal of Telerehabilitation. 2021; 13e6371
- Natality, 2016-2020 expanded results.
- Telehealth and the digital divide as a social determinant of health during the covid-19 pandemic.Network Modeling and Analysis in Health Informatics and Bioinformatics. 2021; 10: 26
- Telehealth: Opportunities to improve access, quality, and cost in pediatric care.Pediatrics. 2022; 149
- Risk factors for hospital readmission and follow up after NICU discharge of infants born at extremely low gestational age in metropolitan Melbourne.International Journal of Pediatric Research. 2017; 3: 028
- Explorations in quality assessment and monitoring: The definition of quality and approaches to its assessment.Health Administration Press, 1980
- The expanding digital divide: Digital health access inequities during the COVID-19 pandemic in new York City.Journal of Urban Health. 2021; 98: 183-186
- What is GIS?.
- Improving mental health outcomes of parents of infants treated in neonatal intensive care units: A scoping review.Journal of Neonatal Nursing. 2021; 1-8
- Parents of premature infants get lifeline with nurses when baby leaves the hospital.Miami Herald, 2022, April 25
- The transition home of extremely premature babies: An integrative review.Journal of Neonatal Nursing. 2021; 27: 26-32
- Patient connectivity with healthcare professionals and health insurer using digital health technologies during the COVID-19 pandemic: A German cross-sectional study.BMC Medical Informatics and Decision Making. 2021; 21: 250
- Changes in emergency department activity and the first COVID-19 lockdown: A cross-sectional study.Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health. 2021; 22: 603-607
- Internet videoconferencing for patient–clinician consultations in long-term conditions: A review of reviews and applications in line with guidelines and recommendations.Digital Health. 2019; 5 (2055207619845831)
- Transition to multidisciplinary pediatric telerehabilitation during the COVID-19 pandemic: Strategy development and implementation.International Journal of Environmental Research and Public Health. 2021; 18: 1484
- Impact of the COVID-19 pandemic on neonatal admissions in a tertiary children’s hospital in Southwest China: An interrupted time-series study.PLoS One. 2022; 17e0262202
- Cost-effectiveness of the collaborative care to preserve performance in cancer (COPE) trial tele-rehabilitation interventions for patients with advanced cancers.Cancer Medicine. 2020; 9: 2723-2731
- Transition of premature infants from hospital to home life.Neonatal Network. 2012; 31: 207-214
- Transitions theory: Middle range and situation specific theories in research and practice.Springer Publishing Company, 2010
- Increased prevalence of severe neonatal hyperbilirubinaemia during social distancing.Journal of Paediatrics and Child Health. 2022; 1-5
- An intervention to improve transitions from NICU to ambulatory care: Quasi-experimental study.BMJ Quality and Safety. 2014; 23: e3
- Persons with dementia and their caregivers’ perceptions about occupational therapy and telehealth: A qualitative descriptive study.Home Healthcare Now. 2018; 36: 369-378
- Home-based telemedicine for children with medical complexity.Telemedicine and E-Health. 2019; 25: 1123-1132
- Telemedicine in children with medical complexity on home ventilation during the COVID-19 pandemic.Pediatric Pulmonology. 2021; 56: 1395-1400
- Hospital admission and emergency department utilization in an infant Medicaid population.Hospital Pediatrics. 2016; 6: 587-594
- Inpatient telehealth experience of patients with limited English proficiency: Cross-sectional survey and semistructured interview study.JMIR Formative Research. 2022; 6e34354
- Telerehabilitation: Review of the state-of-the-art and areas of application.JMIR Rehabilitation and Assistive Technologies. 2017; 4e7
- Child and adolescent health needs assessment.in: 2018-PRC-Child-Adolescent-Health-Needs-Assessment-Nicklaus.pdf. 2018
- Impact of the COVID-19 pandemic on perinatal care and outcomes in the United States: An interrupted time series analysis.Birth. 2021; 1-12
- Scoping review of the mental health of parents of infants in the NICU.Journal of Obstetric, Gynecologic & Neonatal Nursing. 2017; 46: 576-587
- Telemedicine video visits for children with medical complexity in a structured clinical complex care program. Global.Pediatric Health. 2020; 7 (2333794X20952196)
- RN-mentor podcast.([Audio podcast])https://www.alirtayyeb.com/rnmentor-podcast/dasDate: 2022, May 17
- Impact of a transition home program on rehospitalization rates of preterm infants.The Journal of Pediatrics. 2017; 181: 86-92
- Primary-care registered nurse telehealth policy implications.Journal of Telemedicine and Telecare. 2020; 1357633X20940142
- Complex surgical infants benefit from postdischarge telemedicine visits.Advances in Neonatal Care. 2018; 18: 22-30
- Towards development of guidelines for virtual administration of paediatric standardized language and literacy assessments: Considerations for clinicians and researchers.SAGE Open Medicine. 2021; 9 (20503121211050510)
Article info
Publication history
Published online: September 15, 2022
Accepted:
September 1,
2022
Received in revised form:
August 26,
2022
Received:
July 15,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
