Lead Organization: University of Virginia (UVA) Health System
Program Name: Building Hope
Area of Care: Pediatric (NICU Early Discharge, congenital heart, oncology, cystic fybrosis, solid organ transplant)
Healthcare Partners: UVA Health System – Includes a hospital, level 1 trauma centre, nationally recognized cancer and heart centres and primary and specialty clinics throughout Central Virginia
Vendor: Locus Health
lower length of stay (LOS) than the overall average NICU LOS
- Transform and improve the outdated paper process of recording vitals with a binder and pencil and instead virtually connect families with the clinical team in an integrated care model post hospital discharge
- Keep the care team connected in the same way they would if the infant had remained in the hospital
- Reduce length of stay for premature infants admitted to the UVA Children’s Hospital Neonatal ICU
- Increase quality of life for families
- Improve the quality and timeliness of transitions home while ensuring that these infants thrive in the same way if not more quickly than infants in the hospital
- Increase the capacity of the NICU by improving throughput and freeing up beds
The Building HOPE program is a pediatric remote monitoring program that enables a clinical connection for follow-up care and communication with families who can care for their infants at home post hospital discharge.
Initially developed for parents of infants with congenital heart disease, the program has expanded to include other conditions. Parents of infants who are eligible to be remotely monitored are provided with a personalized tablet with a pre-loaded app that enables them to “take the care team home” with them at discharge. Families are shown how to enter key metrics (e.g. daily weights, daily feeding intake, output, SpO2) and how to identify and understand the same trends observed daily by the clinical team.
In addition, the clinical team provides timely educational content directly through the tablet that otherwise would have been sent home in an infrequently used binder of printed materials. Parents can use secure photo and video capabilities through the app to support critical interaction with the care teams, including support for lactation consults.
Neonatology teams use the platform to both round virtually and review alert notifications through the mobile app for clinicians. This aids in helping the care team manage each patient case and identify trends outside of acceptable parameters well in advance of possible emergent events.
A remote patient monitoring (RPM) platform was used and supports this model through:
- capture of biometrics
- secure sharing of biometrics with clinicians
- educational content
- ability to analyze trends and patterns
- secure photo and video transmission
- secure dashboards for clinicians containing vital signs, alerts and trended views
- insightful data to guide ongoing care and improve outcomes
Infants remotely monitored at home gained weight comparably and required the same average days to transition to full oral feeding as the in-hospital control group.
There were no short-term unplanned readmissions or NG tube malfunctions in the RPM group.
The average NICU length of stay (LOS) for infants discharged home in the program was 8.1 days lower than the control group (approximately 33% lower than the overall average NICU LOS). (https://doi.org/10.1111/chd.12693)
Percentage of oral feeds increased significantly in the remote patient monitoring infant group, from a 12% increase prior to discharge to a 57% increase at home, indicating the benefit of developing full oral skills outside the hospital setting.
Change Required to Support the Model
Staff who collected patient-reported outcomes enjoyed time savings due to the platform’s ability to push surveys and receive responses. Nursing time saved was reallocated to support this model. Due to the ability to quickly read contextualized and relevant patient data, nurses were able to monitor more patients. The generation of alerts and ability to view data trends enabled nurses to focus on critical cases first, and quickly virtually connect with families to advise on the best care for their infants.
Locus Health supported the implementation into UVA with an external clinical support team to help monitor remote patients. Locus Health worked with the children’s hospital to figure out the best workflow with the clinical team and engaged families about the program design before launching.
Approximately 10-12% of UVA’s NICU admissions are eligible for this program.
Since late January 2018, more than 100 infants have been enrolled into the program.
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