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Stuart J, Sheridan N, Cloutier P, Reid S, Tse S, Spettigue W, Gray C. Pediatric emergency mental health presentations during early COVID-19: Comparing virtual and in-person presentations. Clin Child Psychol Psychiatry 2024:13591045241286562. [PMID: 39419633 DOI: 10.1177/13591045241286562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
Purpose: Increased mental health (MH) needs during the COVID-19 pandemic led to the implementation of a novel pediatric Emergency Department Virtual Care (EDVC) service. Our study aimed to describe the pediatric MH patient population that used EDVC by comparing patient-specific factors of those who obtained services virtually to those seen in-person. Method: This retrospective chart review was conducted at a pediatric hospital in Eastern Ontario. Children and youth (aged 3-17) who received virtual or in-person emergency MH services from May to December 2020 were included. Patient demographics, clinical presentation details and disposition were compared between the virtual and in-person groups. Data was analyzed using descriptive statistics. Results: 1104 youth (96.1%) utilized the in-person ED for MH concerns; 45 (3.9%) used EDVC. In-person youth had a higher level of perceived risk (78.9% vs. 41.9%) and were more likely to present with concerns of depression, suicidal ideation, self-harm, or laceration (46.1% vs. 35.6%). Anxiety/situational crises or behavioural issues were more likely to present virtually. Eight patients (17.8%) were redirected to the ED from EDVC. Conclusions: Several patient-specific factors varied between youth seen in-person or virtually for MH concern. Study results can assist with the design and implementation of virtual MH care platforms.
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Affiliation(s)
- Joanna Stuart
- Children's Hospital of Eastern Ontario Research Institute, Canada
- Faculty of Medicine, University of British Columbia, Canada
| | - Nicole Sheridan
- Children's Hospital of Eastern Ontario Research Institute, Canada
| | | | - Sarah Reid
- Children's Hospital of Eastern Ontario, Canada
- Faculty of Medicine, University of Ottawa, Canada
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Canada
| | - Sandy Tse
- Children's Hospital of Eastern Ontario, Canada
- Faculty of Medicine, University of Ottawa, Canada
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario, Canada
- Faculty of Medicine, University of Ottawa, Canada
- Department of Psychiatry, University of Ottawa, Canada
| | - Clare Gray
- Children's Hospital of Eastern Ontario, Canada
- Faculty of Medicine, University of Ottawa, Canada
- Department of Psychiatry, University of Ottawa, Canada
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Gardner K, Hurley KF. Impact of virtual care on planned rechecks in a pediatric emergency department: a quality improvement project. CAN J EMERG MED 2024; 26:156-163. [PMID: 38342856 DOI: 10.1007/s43678-024-00664-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/30/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND In the absence of accessible urgent follow-up options, emergency physicians may use an in-person recheck (planned return visit) to the Emergency Department (ED) as a safety net for discharged patients. In-person rechecks require travel, triage, and waiting time for patients and families and contribute to ED census. Many of these visits do not result in further investigation or changes in management but can provide reassurance for the family and care providers. We aimed to reduce the volume of in-person rechecks to our ED through an urgent virtual follow-up process. METHODS We conducted a quality improvement project using iterative process mapping and Plan-Do-Study-Act cycles to develop and implement a new model of care for virtual rechecks. An interdisciplinary team tested and refined the virtual care process from December 2020 to June 2022. Outcome, process and balancing measures were tracked continuously and analyzed using statistical process control. RESULTS Baseline data revealed that the majority of in-person rechecks were for young infants with bronchiolitis. Post-implementation of the new process, 50% of all virtual rechecks were for respiratory illnesses. Use of virtual rechecks increased steadily to an average of 6.5 per 1000 ED visits with 58% of all rechecks now completed virtually. The number of in-person rechecks did not decrease during the study period. Virtual rechecks triggered an in-person ED visit in 5.2% of virtual recheck instances. There was no increase in unplanned return ED visits or admissions after implementation of virtual rechecks. CONCLUSION Virtual rechecks can be safely implemented to allow urgent reassessment of patients following an ED visit. Virtual rechecks could be a useful tool for addressing planned reassessments in the pediatric ED, especially during surges of respiratory illness.
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Affiliation(s)
- Katie Gardner
- IWK Health, Dalhousie University, Halifax, NS, Canada.
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Varner C. Une évaluation critique des nouvelles initiatives à l’échelle des systèmes de santé s’impose. CMAJ 2023; 195:E1738-E1739. [PMID: 38110212 PMCID: PMC10727790 DOI: 10.1503/cmaj.231496-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
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Varner C. Critical evaluation of novel health system interventions is essential. CMAJ 2023; 195:E1483-E1484. [PMID: 37931953 PMCID: PMC10627575 DOI: 10.1503/cmaj.231496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Affiliation(s)
- Catherine Varner
- Deputy editor, CMAJ; Schwartz/Reisman Emergency Medicine Institute; Department of Emergency Medicine, Sinai Health, Department of Family & Community Medicine, University of Toronto, Toronto, Ont
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Vanderhout S, Goldbloom EB, Li A, Newhook D, Garcia M, Dulude C. Evaluation Strategies for Understanding Experiences With Virtual Care in Canada: Mixed Methods Study. J Med Internet Res 2023; 25:e45287. [PMID: 37647120 PMCID: PMC10500354 DOI: 10.2196/45287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/04/2023] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Virtual care was rapidly integrated into pediatric health services during the COVID-19 pandemic. While virtual care offers many benefits, it is necessary to better understand the experiences of those who receive, deliver, and coordinate virtual care in order to support sustainable, high-quality, and patient-centered health care. To date, methods implemented to evaluate users' experiences of virtual care have been highly variable, making comparison and data synthesis difficult. OBJECTIVE This study aims to describe evaluation strategies currently used to understand personal experiences with pediatric virtual care in Canada. METHODS In this mixed methods environmental scan, we first distributed a web-based questionnaire to clinical, research, and operational leaders delivering and evaluating pediatric virtual care in Canada. The questionnaire collected information about how experiences with virtual care have been or are currently being evaluated and whether these evaluations included the perspectives of children or youth, families, providers, or support staff. Second, respondents were asked to share the questions they used in their evaluations, and a content analysis was performed to identify common question categories. Third, we conducted semistructured interviews to further explore our respondents' evaluation experiences across 4 domains-evaluation approaches, distribution methods, response rates, and lessons learned-and interest in a core set of questions for future evaluations. RESULTS There were 72 respondents to the web-based questionnaire; among those who had conducted an evaluation, we identified 15 unique evaluations, and 14 of those provided a copy of the tools used to evaluate virtual care. These evaluations measured the virtual care experiences of parents or caregivers (n=15, 100%), children or youth (n=11, 73%), health care providers (n=11, 73%), and support staff (n=4, 27%). The most common data collection method used was electronic questionnaires distributed by email. Two respondents used validated tools; the remainder modified existing tools or developed new tools. Content analysis of the 14 submitted questionnaires revealed that the most common questions were about overall participant satisfaction, the comparison of virtual care to in-person care, and whether participants would choose virtual care options in the future. Interview findings indicate respondents frequently relied on methods used by peers and that a standardized, core set of questions to evaluate experiences with virtual care would be helpful to improve evaluation practices and support pediatric health care delivery. CONCLUSIONS At our institution and elsewhere in Canada, experiences with pediatric virtual care have been evaluated using a variety of methods. A more consistent evaluation approach using standardized tools may enable more regular comparisons of experiences with virtual care and the synthesis of findings across health care settings. In turn, this may better inform our approach to virtual care, improve its integration into health systems, and facilitate sustainable, high-quality, patient-centered care.
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Affiliation(s)
- Shelley Vanderhout
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ellen B Goldbloom
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Amy Li
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dennis Newhook
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Meghan Garcia
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Catherine Dulude
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Buba M, Dulude C, O'Donnell R, Rowan-Legg A, Sloan M, Nelson M, King WJ. Virtual family-centered rounds: a quality improvement initiative to adapt inpatient care during COVID-19 using a human-centred participatory design approach. BMC Pediatr 2023; 23:289. [PMID: 37312074 DOI: 10.1186/s12887-023-04091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 05/23/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Family-centered rounds (FCR) are fundamental to pediatric inpatient care. During the COVID-19 pandemic, we aimed to design and implement a virtual family-centered rounds (vFCR) process that allowed continuation of inpatient rounds while following physical distancing guidelines and preserving personal protective equipment (PPE). METHODS A multidisciplinary team developed the vFCR process using a participatory design approach. From April through July 2020, quality improvement methods were used to iteratively evaluate and improve the process. Outcome measures included satisfaction, perceived effectiveness, and perceived usefulness of vFCR. Data were collected via questionnaire distributed to patients, families, staff and medical staff, and analyzed using descriptive statistics and content analysis. Virtual auditors monitored time per patient round and transition time between patients as balancing measures. RESULTS Seventy-four percent (51/69) of health care providers surveyed and 79% (26/33) of patients and families were satisfied or very satisfied with vFCR. Eighty eight percent (61/69) of health care providers and 88% (29/33) of patients and families felt vFCR were useful. Audits revealed an average vFCR duration of 8.4 min (SD = 3.9) for a single patient round and transition time between patients averaged 2.9 min (SD = 2.6). CONCLUSION Virtual family-centered rounds are an acceptable alternative to in-person FCR in a pandemic scenario, yielding high levels of stakeholder satisfaction and support. We believe vFCR are a useful method to support inpatient rounds, physical distancing, and preservation of PPE that may also be valuable beyond the pandemic. A rigorous process evaluation of vFCR is underway.
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Affiliation(s)
- Melanie Buba
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Catherine Dulude
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Roisin O'Donnell
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Anne Rowan-Legg
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Megan Sloan
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Matthew Nelson
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - W James King
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
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Lawrence J, Truong D, Dao A, Bryant PA. Virtual hospital-level care—feasibility, acceptability, safety and impact of a pilot Hospital-In-The-Home model for COVID-19 infection. Front Digit Health 2023; 5:1068444. [PMID: 37090066 PMCID: PMC10113639 DOI: 10.3389/fdgth.2023.1068444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/22/2023] [Indexed: 04/08/2023] Open
Abstract
BackgroundHospital-in-the-Home (HITH) delivers hospital level care to patients in the comfort of their own home. Traditionally HITH involves clinicians travelling to patients' homes. We designed and implemented a virtual model of care leveraging a combination of virtual health modalities for children with COVID-19 in response to rising patient numbers, infection risk and pressures on protective equipment. In contrast to other models for COVID-19 infection in Australia at the time, our HITH service catered only for children who were unwell enough to meet criteria for hospitalisation (ie bed-replacement).AimsTo measure the feasibility, acceptability, safety and impact of a virtual model of care for managing children with COVID-19 infection requiring hospital-level care.MethodsRetrospective study of a new virtual model of care for all children admitted to the Royal Children's HITH service with COVID-19 infection between 7th October 2021 and 28th April 2022. The model consisted of at least daily video consultations, remote oximetry, symptom tracking, portal messaging and 24 h phone and video support. Patients were eligible if they met a certain level of severity (work of breathing, dehydration, lower oxygen saturations) without requiring intravenous fluids, oxygen support or intensive care. Online surveys were distributed to staff and consumers who experienced the model of care.Results331 patients were managed through the virtual HITH program with a mean length of stay of 3.5 days. Of these, 331 (100%) engaged in video consultations, 192 (58%) engaged in the patient portal and completed the symptom tracker a total of 634 times and communicated via a total of 783 messages. Consumer satisfaction (n = 31) was high (4.7/5) with the most useful aspect of the model rated as video consultation. Clinician satisfaction (n = 9) was also high with a net promoter score of 8.9. There were no adverse events at home. Eight children (2.4%) represented to hospital, 7 (2.1%) of whom were readmitted. The impact is represented by a total of 1,312 hospital bed-days saved in the seven-month period (2,249 bed-days per year). In addition, 1,480 home visits (travel time/ protective equipment/ infection risk) were avoided.ConclusionA virtual HITH program for COVID-19 in children is feasible, acceptable and safe and has a substantial impact on bed-days saved and nursing travel time. The implications for management of other acute respiratory viral illnesses that contribute to hospital bed pressure during winter months is immense. Virtual HITH is likely to be a key enabler of a sustainable healthcare system.
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Affiliation(s)
- J. Lawrence
- Electronic Medical Record Team, Royal Children’s Hospital, Melbourne, VIC, Australia
- Hospital-in-the-Home Department, Royal Children’s Hospital, Melbourne, VIC, Australia
- Health Services Research Unit, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Correspondence: J. Lawrence
| | - D. Truong
- Electronic Medical Record Team, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - A. Dao
- Electronic Medical Record Team, Royal Children’s Hospital, Melbourne, VIC, Australia
- Radiology Department, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - P. A. Bryant
- Hospital-in-the-Home Department, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Infectious Disease Unit, Royal Children’s Hospital, Melbourne, VIC, Australia
- Clinical Paediatrics Group, Murdoch Children’s Research Institute, Melbourne, Australia
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