Background: The transition from the neonatal intensive care unit (NICU) to home is a challenging time for caregivers of medically complex infants. Discharging patients in a safe and efficient manner can also present many challenges for health care providers. Telemedicine can improve the complex infant’s transition to home for caregivers and health care providers alike. Objectives: 1) To identify issues encountered by caregivers’ post discharge. 2) To evaluate the efficacy of video communication during post-discharge telemedicine visits. 3) To identify areas of improvement in the discharge process. 4) To evaluate caregiver satisfaction. Design/Methods: This project is phase 1 of a quality improvement initiative in a quaternary NICU. Caregivers of infants being discharged with medical equipment participated in a telemedicine visit with neonatal providers within one week of discharge. Providers reviewed a checklist with caregivers regarding infant health, equipment use, and follow-up. Video was used to visualize the infant, home environment, and care practices. Caregivers were questioned about their experience with the unit’s discharge process. After the visit, caregivers completed an anonymous satisfaction survey using visual analog scales (0=not at all satisfied, 100=extremely satisfied). Results: 52 telemedicine visits with medically complex infants were performed from 5/2015 to 11/2016. The visits evaluated respiratory support, tube feedings, management of surgical wound sites, and advanced medication administration. 42 issues were identified by verbal report (Figure 1). Video identified or confirmed 14 issues related to surgical sites, sleep environment, respiratory status, or dermatologic concerns. A telemedicine visit prevented an additional call or visit to a medical provider in 25/52 (48%) visits and prompted an earlier medical visit in 6/52 (12%) visits. These visits also provided valuable insight into the discharge process and identified areas for improvement (Table 1). After the visit, 26 caregivers completed the anonymous satisfaction survey. The median rating for caregiver satisfaction was 94.5. Conclusions: Post-discharge telemedicine visits with medically complex infants provide caregivers with additional support during the transition to home as well as identify areas for improvement in the discharge process. Phase one identified improvement targets for phase two: Reducing post discharge knowledge and practice gaps in caregivers of complex neonatal infants by improving the discharge process in combination with telemedicine follow up.

Issues identified at visits

Issues identified at visits

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Category of discharge issues identified

Category of discharge issues identified

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