O2180: Telehealth Handoffs in the NICU to Home Transition

Purpose/Objectives: 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: Patients admitted to the level IV NICU at our institution undergoing discharge preparation in 2021-2023 after a prolonged inpatient stay. Based on provider determination, ‘medically complex’ babies with technology needs post discharge were identified and recommended for participation in a telehealth discharge visit. Patients' information was reviewed within the electronic medical record (EMR) 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.

Results: 39 patients deemed as being 'complex' were discharged from the NICU during the study period. The gestational age (GA) of the patients included ranged from 24 weeks to 39 weeks with mean GA of 31 weeks. Patients had a minimum of 3 discrete diagnoses at discharge with 43% having more than 10 diagnoses. 97% of the patients went home with some form of durable medical equipment (DME) and only 2 patients did not have more than one piece of medical equipment. 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 compared to the traditional discharge letter or telephone handoff and 100% felt it assisted in their understanding of the patient, as well as allowed the first visit with the patient to go more smoothly. 88% felt that they were able to accommodate the telemedicine visit during regular work day. 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 work day.

Conclusion/Discussion: Patients can be deemed complex for a variety of reasons but those with multiple diagnosis, medication, medical equipment, and specialist following them can be daunting for families and providers. Having a streamline process to help aid in the transition of these patients to the community seems beneficial for all involved and reduces hospital readmission. Further changes to our current means of doing this in the future would help make parents feel more involved and knowledgeable about the conversation between providers.