JMIR Publications

ABSTRACT

Background:

Family caregivers (FC) of children with medical complexity require specialized support to promote safe management of medical technologies (e.g., central lines, gastrostomy tubes) during hospital to home transitions. With limited after-hours services available to families in home and community care, medical device complications that arise often lead to increased FC stress and unplanned trips to the emergency department (ED). To improve FC experiences, enable safer discharge of children with new medical technology, and reduce after-hours ED visits, this study explores the feasibility of piloting a 24/7 virtual care service (Connected Care Live) with families to provide real-time support by clinicians expert in the use of homecare technologies.

Objective:

This study aims to establish the economic, operational, and technical feasibility of piloting the expansion of an existing nurse-led after-hours virtual care service offered to home and community care providers, to FCs of children with newly inserted medical devices post-hospital discharge at Toronto’s Hospital for Sick Children (SickKids).

Methods:

This exploratory study, from October 2020 to August 2021, used mixed data sources to inform the feasibility of service expansion. Semi-structured interviews were conducted with FCs, nurses, and hospital leadership to assess the risks, benefits, and technical and operational requirements for sustainable and cost-effective future service operations. Time and travel savings were estimated using ED visits data found in SickKids’ electronic medical records, Epic, with a chief complaint of “medical device problem,” after-hours medical device inquiries from clinician emails and voicemails, and existing service operational data.

Results:

30 stakeholders were interviewed and voiced the need for the proposed service. Safer and more timely management of medical device complications, improved caregiver and provider experiences, and strengthened partnerships were identified as expected benefits, while service demand, nursing practice, and privacy and security were identified as potential risks. A total of 47 inquiries were recorded over a 2-week period from March 26, 2021, to April 8, 2021, with 53% assessed as manageable via the new service. This study forecasted an annual time and travel savings of 652 hours for SickKids and 1,184 hours and 27, 072 km for families. Minimal technical and operational requirements were needed to support service expansion by leveraging an existing platform and clinical staff. Of the 212 “medical device problem” ED visits found over a 6-month period from September 1, 2020, to February 28, 2021, enteral feeding tubes accounted for nearly two thirds (n=137, 65%) with 50% assessed as virtually manageable.

Conclusions:

Our findings indicate that it is feasible to pilot the expansion of Connected Care Live to FCs of children with newly inserted enteral feeding tubes. This nurse-led virtual caregiver service is a promising tool to promote safe hospital to home transitions, improve FC experiences, and reduce after-hours ED visits.