P0999 - A Multicenter Telemedicine Handoff Pilot to Improve the Transition of Care from NICU to PCPs and Families

Background: Medically complex infants are discharged from the Neonatal Intensive Care Unit (NICU) with complicated, multifaceted care needs that must transition from the NICU home, to their family and their primary care providers (PCPs). Critical to such management is the accurate and prompt transmission of important and relevant clinical information from the NICU team to the PCP. Currently, such communication happens largely by the discharge summary and occasionally via telephone calls. Despite these efforts, nuances of care may be lost in communication. Completing these handoffs by telemedicine could be a way to ensure that PCPs and caregivers have more complete and robust information.

Methods: Infants nearing discharge from three university children’s hospital NICUs are eligible to participate if they have medical equipment needs at discharge, greater than 3 discharge medications, wound care concerns, concerns for growth failure, or are being followed by one or more subspecialty services after discharge. Infants are excluded if their PCPs visited them in the hospital. A written discharge summary is also sent to the PCP per each institution’s protocol. The telemedicine handoff occurs either in the NICU before discharge or at the infants’ first PCP appointment with the family, neonatal provider, and PCP present. All three parties are asked to complete a short web survey with both quantitative and qualitative elements shortly after the handoff. The survey was created through iterative review by the SPROUT Neonatal Topic Working Group and was based on the SPROUT Measurement Framework. All three institutional review boards reviewed this project and determined it to be an exempt quality improvement project.

Results: Twenty-two telemedicine handoffs have occurred across the three sites. Of these, five have all three sets of surveys complete and three have no surveys. Response rates were as follows: 55% (N=12) for parents, 50% (N=11) for PCPs, and 68% for neonatal providers. 63% of PCPs that responded and 60% of neonatal providers that responded said that the handoff provided information that a written or phone handoff would not have and indicated that the benefits outweighed the effort (Table 1). All respondents indicated that they were likely to recommend these handoffs (Table 1). Qualitative feedback from PCPs and neonatal providers resulted in three primary themes: Handoff as opportunity to clarify plan, Handoff provides venue to answer questions, and Handoff expands on traditional signout (Table 2).

Conclusion: Early results from a telemedicine handoff study involving infants, neonatal providers, and PCPs indicate that these handoffs can provide benefits and more detail than traditional methods of signout. Our study team plans to continue these handoffs until we have fifty triads of surveys completed. Lessons learned from this project can inform improvements to the discharge planning process.