(47 - Friday) Evaluation of a Respiratory Therapist Driven Parental Education Program for Technology-Dependent Children in the Acute Care Setting of a Pediatric Hospital

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Abstract:

Introduction: Initial hospital discharge to the home of technology-dependent children (tracheostomy, ventilator, gastronomy tube) requires extensive training and education of the family caregivers. These children have prolonged hospital length of stay secondary to the inability to transfer to sub-acute teaching facilities due to lack of specific insurance plans and unavailable bed space, forcing institutions to develop their own education home transition programs. Despite developing these “in-house” training programs, the 30-day readmission rate after initial hospital discharge remains high, averaging 27% based on literature.

Methods: We evaluated the performance of our unique respiratory therapist (RT)-led physician supported model parental education program for respiratory-technology-dependent pediatric patients in the acute care setting (CICU, PICU, NICU) in a tertiary children’s hospital. This program provided a single contact for caregivers and outside agencies, a single RT educator for the caregivers, and a clinical pathway that involved the entire multidisciplinary team. Multiple teaching tools, activities, and training sessions, based on adult learning theory were utilized to develop appropriate clinical skills to manage children with tracheostomies and the associated technological supports. Durable Medical Equipment (DME) companies partnered with the RT educator and Case Management to streamline parental education and home equipment. ICU nurses assisted with parental gastrostomy tube education and medication administration.

Results: A 6-week parental teaching program was created that included structured, practical, family-focused, and patient-customized education. All teaching was conducted and completed in the ICU where the patient was hospitalized (Fig 1/2). Parental education included a consistent syllabus tailored to the objectives specific to the patient’s situation and the parent’s learning ability. Since March 2021, we have completed education and discharged to the home 7 medically fragile children (4 in CICU, 2 in PICU, and 1 in NICU). There have been no reported mortalities and only one tracheostomy tube-related readmission. Our 30-day readmission rate was 0% compared to 27% (p < 0.0001) documented in the literature.

Conclusion: We demonstrate that a 6-week acute care RT-led physician-supported dyad parental education program for medically fragile, ventilator-dependent children, is not only safe and successful for initial hospital discharge but far outperformed other models in the literature related to 30-day readmission rate.