PM1015: Parent Discharge Education and Readiness for the Transition to Home After Congenital Heart Surgery

Background: Hospital discharge teaching and parent discharge readiness is linked to successful home care and reduced hospital readmissions. This has been demonstrated in the medical-surgical adult population. This is not as well described within the congenital heart disease population. This study aims to describe current discharge readiness practices provided for patient families after congenital heart surgery at Cincinnati Children’s Hospital. We hypothesize families with higher SES, older patients, and repeat surgeries will report higher discharge readiness scores.

Methods: The population under investigation were parents of congenital heart surgery patients (0 to 18 years). Exclusion criteria included non-English speaking families and patients who were transferred to a long-term care facility or another hospital. Families were prospectively enrolled and completed a validated survey instrument (Modified Readiness for Hospital Discharge Scale, mRHDS) assessing parent discharge readiness. These were administered on the day of discharge. Data collection included descriptive patient characteristics and clinical engagement.

Results: We enrolled 128 families during April to December 2021. Medians with percentiles and frequencies with percentiles were used to describe the demographic and clinical characteristics of survey respondents. The mRDHS score includes five subcategories: Parent Personal Status (1), Child Personal Status (2), Knowledge (3), Coping Ability (4), and Expected Support (5). The mRHDS score ranges from Very High (9-10), High (8-8.9), Moderate (7-7.9), and Low ( < 7). Formal testing of differences in discharge readiness were performed. Independent risk factors of interest included surgical complexity, socioeconomic status (SES), medical complexity, age, and initial surgery. Clinical engagement 30 days post-discharge included phone calls, clinic visits, emergency department visits, and hospital readmissions.

Overall, parents’ mRHDS scores were rated 'High' to 'Very High' with some variation in subcategories. In terms of clinical engagement, lower SES families had a higher propensity for ED visits (34% vs 15% p=0.02) and hospital readmissions (32% vs 15% p=0.03, Chi-square test of independence). This was also true for interstage patients and infants versus older children (42% vs 27% vs 10% p=0.02) for ED visits and hospital readmissions (67% vs 21% vs 10% p= < 0.001).

Conclusion: This is the first study of this size characterizing parent discharge readiness in the CHD surgical population. The results suggest that families are ready for discharge but there is incongruity with clinical engagement metrics. This is highlighted by higher score responses among more vulnerable populations including younger patients, lower SES clusters, and first time surgeries which is contrary to our hypothesis. There are multiple factors that could account for these trends including response bias, overconfidence, or ineffective real world preparation. Our next steps include the development of a novel discharge education tool using virtual reality simulation to provide realistic scenarios of common post-operative complications to help prepare families for the transition to home.