Telehealth for Discharge Outcomes in Children: A Feasibility Study

Patient transitions from hospital to home have increasingly become recognized as a critical opportunity to promote patient safety and high quality care, both at University of California Davis Medical Center and nationwide. With over 16,000 children discharged from U.S. hospitals each day and a rate of 1 in 5 experiencing adverse events related to this process, it is estimated that hospital-to-home transition-related adverse events affect over 1.1 million children annually. The quality of hospital discharge also affects hospital readmission rates, length of hospital stay, and parental satisfaction.

Discharge transition difficulties stem largely from care coordination failures throughout the hospital-to-home transition. The investigators recently conducted a qualitative study analyzing perspectives from parents and physicians of 20 children readmitted within 30 days of hospital discharge. The study identified a theme of caregivers having difficulty re-connecting to the child's medical team for ongoing care after discharge. When problems arose, caregivers reported challenges in knowing who to contact, when to reach out for help, and how to navigate the health system to prevent readmission.

The advent of telehealth presents a unique opportunity to provide seamless follow-up for families following hospital discharge. Although telehealth has not previously been studied as a means of providing pediatric follow-up care after hospital discharge, similar methods of providing post-discharge hospital follow-up, including nurse- or physician-led phone calls and nurse home visits, were highly regarded by families, but failed to impact readmission rates. Telehealth provides a unique advantage over these alternate interventions by allowing face-to-face interaction via videoconference between the patient, caregiver, and hospital physician, who is already familiar with the patient's disease course and overall trajectory. At the investigators' site, although telehealth is readily available for use in most any clinical setting, it is not commonly used for hospital discharge follow-up. Therefore, this study proposes to test the feasibility of a telehealth follow-up visit for patients and their caregivers who were recently discharged from a general pediatric inpatient unit.