Advertisement

A telehealth nursing intervention to improve the transition from the neonatal intensive care unit to home for infants & caregivers: Preliminary evaluation

Published:September 15, 2022DOI:https://doi.org/10.1016/j.pedn.2022.09.003

      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 access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Akhbari Ziegler S.
        • Hadder-Algra M.
        Coaching approaches in early intervention and paediatric rehabilitation.
        Developmental Medicine and Child Neurology. 2020; 62: 569-574
        • American Academy of Ambulatory Care Nursing
        Telehealth nursing practice.
        • Baker-Smith C.M.
        • Sood E.
        • Prospero C.
        • Zadokar V.
        • Srivastava S.
        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
        • Barnes C.R.
        • Adamson-Macedo E.N.
        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
        • Bican R.
        • Christensen C.
        • Fallieras K.
        • Sagester G.
        • O’Rourke S.
        • Byars M.
        • Tanner K.
        Rapid implementation of telerehabilitation for pediatric patients during COVID-19.
        International Journal of Telerehabilitation. 2021; 13e6371
        • Centers for Disease Control and Prevention
        Natality, 2016-2020 expanded results.
        • Clare C.A.
        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
        • Curfman A.
        • Hackell J.M.
        • Herendeen N.E.
        • Alexander J.
        • Marcin J.P.
        • Moskowitz W.B.
        • McSwain S.D.
        Telehealth: Opportunities to improve access, quality, and cost in pediatric care.
        Pediatrics. 2022; 149
        • Doctor T.
        • Harnaen E.
        • Seith B.
        • Tan K.
        • Craig S.
        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
        • Donabedian A.
        Explorations in quality assessment and monitoring: The definition of quality and approaches to its assessment.
        Health Administration Press, 1980
        • Eruchalu C.N.
        • Pichardo M.S.
        • Bharadwaj M.
        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
        • esri
        What is GIS?.
        • Galea M.
        • Park T.
        • Hegadoren K.
        Improving mental health outcomes of parents of infants treated in neonatal intensive care units: A scoping review.
        Journal of Neonatal Nursing. 2021; 1-8
        • Granfield C.
        Parents of premature infants get lifeline with nurses when baby leaves the hospital.
        Miami Herald, 2022, April 25
        • Green J.
        • Fowler C.
        • Petty J.
        • Whiting L.
        The transition home of extremely premature babies: An integrative review.
        Journal of Neonatal Nursing. 2021; 27: 26-32
        • Hannemann N.
        • Götz N.A.
        • Schmidt L.
        • et al.
        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
        • Honeyford K.
        • Coughlan C.
        • Nijman R.G.
        • Expert P.
        • Burcea G.
        • Maconochie I.
        • Costelloe C.E.
        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
        • Ignatowicz A.
        • Atherton H.
        • Bernstein C.J.
        • Bryce C.
        • Court R.
        • Sturt J.
        • Griffiths F.
        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)
        • Krasovsky T.
        • Silberg T.
        • Barak S.
        • Eisenstein E.
        • Erez N.
        • Feldman I.
        • Sarna H.
        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
        • Liu W.
        • Yang Q.
        • Xu Z.E.
        • Hu Y.
        • Wang Y.
        • Liu Z.
        • Hua Z.
        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
        • Longacre C.F.
        • Nyman J.A.
        • Visscher S.L.
        • Borah B.J.
        • Cheville A.L.
        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
        • Lopez G.L.
        • Anderson K.H.
        • Feutchinger J.
        Transition of premature infants from hospital to home life.
        Neonatal Network. 2012; 31: 207-214
        • Meleis A.J.
        Transitions theory: Middle range and situation specific theories in research and practice.
        Springer Publishing Company, 2010
        • Mokha S.
        • Heintz C.
        • Agrawal V.
        • Reynolds A.M.
        • Berkelhamer S.K.
        Increased prevalence of severe neonatal hyperbilirubinaemia during social distancing.
        Journal of Paediatrics and Child Health. 2022; 1-5
        • Moyer V.A.
        • Papile L.A.
        • Eichenwald E.
        • Giardino A.P.
        • Khan M.M.
        • Singh H.
        An intervention to improve transitions from NICU to ambulatory care: Quasi-experimental study.
        BMJ Quality and Safety. 2014; 23: e3
        • Nissen R.M.
        • Hersch G.
        • Tietze M.
        • Chang P.J.
        Persons with dementia and their caregivers’ perceptions about occupational therapy and telehealth: A qualitative descriptive study.
        Home Healthcare Now. 2018; 36: 369-378
        • Notario P.M.
        • Gentile E.
        • Amidon M.
        • Angst D.
        • Lefaiver C.
        • Webster K.
        Home-based telemedicine for children with medical complexity.
        Telemedicine and E-Health. 2019; 25: 1123-1132
        • Onofri A.
        • Pavone M.
        • De Santis S.
        • Verrillo E.
        • Caggiano S.
        • Ullmann N.
        • Cutrera R.
        Telemedicine in children with medical complexity on home ventilation during the COVID-19 pandemic.
        Pediatric Pulmonology. 2021; 56: 1395-1400
        • Paul D.A.
        • Agiro A.
        • Hoffman M.
        • Denemark C.
        • Brazen A.
        • Pollack M.
        • Ehrenthal D.
        Hospital admission and emergency department utilization in an infant Medicaid population.
        Hospital Pediatrics. 2016; 6: 587-594
        • Payvandi L.
        • Parsons C.
        • Bourgeois F.C.
        • Hron J.D.
        Inpatient telehealth experience of patients with limited English proficiency: Cross-sectional survey and semistructured interview study.
        JMIR Formative Research. 2022; 6e34354
        • Peretti A.
        • Amenta F.
        • Tayebati S.K.
        • Nittari G.
        • Mahdi S.S.
        Telerehabilitation: Review of the state-of-the-art and areas of application.
        JMIR Rehabilitation and Assistive Technologies. 2017; 4e7
        • Professional Research Consultants
        Child and adolescent health needs assessment.
        in: 2018-PRC-Child-Adolescent-Health-Needs-Assessment-Nicklaus.pdf. 2018
        • Riley T.
        • Nethery E.
        • Chung E.K.
        • Souter V.
        Impact of the COVID-19 pandemic on perinatal care and outcomes in the United States: An interrupted time series analysis.
        Birth. 2021; 1-12
        • Roque A.T.F.
        • Lasiuk G.C.
        • Radünz V.
        • Hegadoren K.
        Scoping review of the mental health of parents of infants in the NICU.
        Journal of Obstetric, Gynecologic & Neonatal Nursing. 2017; 46: 576-587
        • Ross M.H.
        • Parnell L.S.
        • Spears T.G.
        • Ming D.Y.
        Telemedicine video visits for children with medical complexity in a structured clinical complex care program. Global.
        Pediatric Health. 2020; 7 (2333794X20952196)
        • Tayyeb A.R.
        RN-mentor podcast.
        ([Audio podcast])
        • Vohr B.
        • McGowan E.
        • Keszler L.
        • Alksninis B.
        • O'Donnell M.
        • Hawes K.
        • Tucker R.
        Impact of a transition home program on rehospitalization rates of preterm infants.
        The Journal of Pediatrics. 2017; 181: 86-92
        • Watkins S.
        • Neubrander J.
        Primary-care registered nurse telehealth policy implications.
        Journal of Telemedicine and Telecare. 2020; 1357633X20940142
        • Willard A.
        • Brown E.
        • Masten M.
        • Brant M.
        • Pouppirt N.
        • Moran K.
        • Lioy J.
        • Chuo J.
        Complex surgical infants benefit from postdischarge telemedicine visits.
        Advances in Neonatal Care. 2018; 18: 22-30
        • Wood E.
        • Bhalloo I.
        • McCaig B.
        • Feraru C.
        • Molnar M.
        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)