607 - Telehealth Handoffs in the NICU to Home transition

Publication Number: 607.6538

Antoniece Duncanson, Phoenix Children's Hospital, Phoenix, AZ, United States; Jennifer Weber, University of Arizona College of Medicine-Phoenix, Phoenix Children’s Hospital, Phoenix, AZ, United States

Background: Phoenix Children's NICU is a level IV unit that cares for many complex neonates. These patients are discharged with chronic diagnoses and require subspecialty follow up, multiple medications, and are often dependent on equipment such as tracheostomy tubes, feeding tubes, and/or home ventilators. There is a need for optimized discharge preparation including communication with the primary care provider and caregiver(s).

Objective: The aim of this study was to determine whether a formal telehealth discharge visit with neonatologist and primary care providers of medically complex infants would improve the transition from NICU to home and whether it reduces readmissions to the hospital.

Design/Methods: Medically complex babies with technology needs post discharge were identified and recommended for participation in a telehealth discharge visit from 2021-2023. Patients' hospital course was reviewed between providers and electronic surveys were distributed to those participating in the telehealth visit (primary care provider [PCP], neonatology provider, parent of patient). Responses from the survey were recorded on a Likert scale. Readmission rates were trended at 7 days and 30 days for all participants.

Results: 39 patients deemed as being 'complex' were discharged from the NICU during the study period. Their gestational ages (GA) ranged from 24 weeks to 39 weeks with mean GA of 31 weeks. Patients had at least 3 discrete diagnoses at discharge with 43% having more than 10 diagnoses. All subjects had 6 or more subspecialist needs or follow up appointments at time of discharge. 22/39 Neonatologist/neonatal nurse practitioner (NNP) completed the telemedicine handoff and filled out the survey while 33/39 PCP returned the survey. Only 9/39 parents completed the survey. 90% of PCP felt that the process provided more information and 100% felt it assisted in their understanding of the patient, allowing the first visit with the patient to go more smoothly. 95% of Neonatologist/NNP felt that the telemedicine handoff was beneficial, improved relationships with community providers and was able to be seamlessly incorporated into the regular workday. Readmission rate at 7 days were 10%, 20% and 7% at 2021, 2022 and 2023 respectively. Readmissions at 30 days were 20%, 6% and 7% during this years.

Conclusion(s): Patients can be complex for a variety of reasons but those with multiple diagnosis, medical equipment, and subspecialist can be daunting for families and providers. Having a streamline process to help in the transition of these patients to the community seems beneficial for all involved and reduces hospital readmission.

Number of diagnosis in complex patients
Graph showing the number of diagnoses in our complex patients in the study

Readmission rates for study
Graph showing the readmission trends during the study period of the study population

Hospital readmissions
Graph showing the NICU readmissions to the hospital

Number of diagnosis in complex patients
Graph showing the number of diagnoses in our complex patients in the study

Readmission rates for study
Graph showing the readmission trends during the study period of the study population

Hospital readmissions
Graph showing the NICU readmissions to the hospital