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Shinjo D, Yotani N, Ito A, Isayama T. Children with medical complexity receiving home healthcare devices in Japan: a retrospective cohort study. BMJ Paediatr Open 2024; 8:e002685. [PMID: 38942589 PMCID: PMC11227824 DOI: 10.1136/bmjpo-2024-002685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/13/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Limited evidence exists regarding children receiving home healthcare devices (HHDs). This study aimed to describe the range and type of HHD use by children with chronic medical conditions in Japan and explore factors leading to increased use of these devices. METHODS This retrospective cohort study was conducted using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Children receiving HHD aged ≤18 years between April 2011 and March 2019 were included. Children newly administered HHD between 2011 and 2013 were followed up for 5 years, and logistic regression analysis was performed to assess the relationship between increased HHD use and each selected risk factor (comorbidity or types of HHD). The models were adjusted for age category at home device introduction, sex and region. RESULTS Overall, 52 375 children receiving HHD were identified. The number (proportion) of children receiving HHD increased during the study period (11 556 [0.05%] in 2010 and 25 593 [0.13%] in 2018). The most commonly administered HHD was oxygen (51.0% in 2018). Among the 12 205 children receiving HHD followed up for 5 years, 70.4% and 68.3% who used oxygen or continuous positive airway pressure, respectively, were released from the devices, while only 25.8% who used mechanical ventilation were released from the device. The following diagnosis/comorbidities were associated with increased HHD use: other neurological diseases (OR): 2.85, 95% CI): 2.54-3.19), cerebral palsy (OR: 2.16, 95% CI: 1.87 to 2.49), congenital malformations of the nervous system (OR: 1.70, 95% CI: 1.34 to 2.13) and low birth weight (OR: 1.68, 95% CI: 1.41 to 2.00). CONCLUSIONS This study provides nationwide population-based empirical data to clarify the detailed information regarding children receiving HHD in Japan. This information could assist healthcare professionals in improving the quality of life of these children and their families and help health policymakers consider measures.
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Affiliation(s)
- Daisuke Shinjo
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
- Department of Information Technology and Management, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Nobuyuki Yotani
- Department of Palliative Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Ai Ito
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Tetsuya Isayama
- Department of Neonatology, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
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Oumarbaeva-Malone Y, Jurgens V, Rush M, Bloom M, Adusei-Baah C, Hall M, Shah N, Bhansali P, Parikh K. Care Models and Discharge Services for Children With Medical Complexity. Hosp Pediatr 2024; 14:102-107. [PMID: 38196385 DOI: 10.1542/hpeds.2023-007423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND AND OBJECTIVES Children with medical complexity (CMC) are high health care utilizers prompting hospitals to implement care models focused on this population, yet practices have not been evaluated on a national level. Our objective with this study is to describe the presence and structure of care models and the use of discharge services for CMC admitted to freestanding children's hospitals across the nation. METHODS We distributed an electronic survey to 48 hospitals within the Pediatric Health Information System exploring the availability of care models and discharge services for CMC. Care models were grouped by type and number present at each institution. Discharge services were grouped by low (never, rarely), medium (sometimes), and high (most of the time, always) frequency use. RESULTS Of 48 eligible hospitals, 33 completed the survey (69%). There were no significant differences between responders and non-responders for both hospital and patient characteristics. Most participants identified an outpatient care model (67%), whereas 21% had no dedicated care model for CMC in the inpatient or outpatient setting. High-frequency discharge services included durable medical equipment delivery, medication delivery, and communication with outpatient provider before discharge. Low-frequency discharge services included the use of a structured handoff tool for outpatient communication, personalized access plans, inpatient team follow-up with family after discharge, and the use of discharge checklists. CONCLUSIONS Children's hospitals vary largely in care model structure and discharge services. Future work is needed to evaluate the associations between care models and discharge services for CMC with various health care outcomes.
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Affiliation(s)
- Yuliya Oumarbaeva-Malone
- Children's National Hospital, Washington DC
- The George Washington University School of Medicine and Health Sciences, Washington DC
| | - Valerie Jurgens
- Children's National Hospital, Washington DC
- The George Washington University School of Medicine and Health Sciences, Washington DC
| | - Margaret Rush
- Children's National Hospital, Washington DC
- The George Washington University School of Medicine and Health Sciences, Washington DC
| | - Miriam Bloom
- Children's National Hospital, Washington DC
- The George Washington University School of Medicine and Health Sciences, Washington DC
| | - Charity Adusei-Baah
- Children's National Hospital, Washington DC
- The George Washington University School of Medicine and Health Sciences, Washington DC
| | | | - Neha Shah
- Children's National Hospital, Washington DC
- The George Washington University School of Medicine and Health Sciences, Washington DC
| | - Priti Bhansali
- Children's National Hospital, Washington DC
- The George Washington University School of Medicine and Health Sciences, Washington DC
| | - Kavita Parikh
- Children's National Hospital, Washington DC
- The George Washington University School of Medicine and Health Sciences, Washington DC
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Glick AF, Farkas JS, Magro J, Shah AV, Taye M, Zavodovsky V, Rodriguez RH, Modi AC, Dreyer BP, Famiglietti H, Yin HS. Management of Discharge Instructions for Children With Medical Complexity: A Systematic Review. Pediatrics 2023; 152:e2023061572. [PMID: 37846504 PMCID: PMC10598634 DOI: 10.1542/peds.2023-061572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 10/18/2023] Open
Abstract
CONTEXT Children with medical complexity (CMC) are at risk for adverse outcomes after discharge. Difficulties with comprehension of and adherence to discharge instructions contribute to these errors. Comprehensive reviews of patient-, caregiver-, provider-, and system-level characteristics and interventions associated with discharge instruction comprehension and adherence for CMC are lacking. OBJECTIVE To systematically review the literature related to factors associated with comprehension of and adherence to discharge instructions for CMC. DATA SOURCES PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Web of Science (database initiation until March 2023), and OAIster (gray literature) were searched. STUDY SELECTION Original studies examining caregiver comprehension of and adherence to discharge instructions for CMC (Patient Medical Complexity Algorithm) were evaluated. DATA EXTRACTION Two authors independently screened titles/abstracts and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results. RESULTS Fifty-one studies were included. More than half were qualitative or mixed methods studies. Few interventional studies examined objective outcomes. More than half of studies examined instructions for equipment (eg, tracheostomies). Common issues related to access, care coordination, and stress/anxiety. Facilitators included accounting for family context and using health literacy-informed strategies. LIMITATIONS No randomized trials met inclusion criteria. Several groups (eg, oncologic diagnoses, NICU patients) were not examined in this review. CONCLUSIONS Multiple factors affect comprehension of and adherence to discharge instructions for CMC. Several areas (eg, appointments, feeding tubes) were understudied. Future work should focus on design of interventions to optimize transitions.
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Affiliation(s)
| | | | - Juliana Magro
- Health Sciences Libraries, NYU Langone Health, New York, New York
| | | | | | | | | | - Avani C. Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | | | - H. Shonna Yin
- Department of Pediatrics
- Department of Population Health, NYU Langone Health, New York, New York
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Huth K, Hotz A, Emara N, Robertson B, Leaversuch M, Mercer AN, Khan A, Campos ML, Liss I, Hahn PD, Graham DA, Rossi L, Thomas MV, Elias N, Morris M, Glader L, Pinkham A, Bardsley KM, Wells S, Rogers J, Berry JG, Mauskar S, Starmer AJ. Reduced Postdischarge Incidents After Implementation of a Hospital-to-Home Transition Intervention for Children With Medical Complexity. J Patient Saf 2023; 19:493-500. [PMID: 37729645 DOI: 10.1097/pts.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Prior research suggests that errors occur frequently for patients with medical complexity during the hospital-to-home transition. Less is known about effective postdischarge communication strategies for this population. We aimed to assess rates of 30-day (1) postdischarge incidents and (2) readmissions and emergency department (ED) visits before and after implementing a hospital-to-home intervention. METHODS We conducted a prospective intervention study of children with medical complexity discharged at a children's hospital from April 2018 to March 2020. A multistakeholder team developed a bundled intervention incorporating the I-PASS handoff framework including a postdischarge telephone call, restructured discharge summary, and handoff communication to outpatient providers. The primary outcome measure was rate of postdischarge incidents collected via electronic medical record review and family surveys. Secondary outcomes were 30-day readmissions and ED visits. RESULTS There were 199 total incidents and the most common were medication related (60%), equipment issues (15%), and delays in scheduling/provision of services (11%). The I-PASS intervention was associated with a 36.4% decrease in the rate of incidents per discharge (1.51 versus 0.95, P = 0.003). There were fewer nonharmful errors and quality issues after intervention (1.27 versus 0.85 per discharge, P = 0.02). The 30-day ED visit rate was significantly lower after intervention (12.6% versus 3.4%, per 100 discharges, P = 0.05). Thirty-day readmissions were 15.8% versus 10.2% postintervention (P = 0.32). CONCLUSIONS A postdischarge communication intervention for patients with medical complexity was associated with fewer postdischarge incidents and reduced 30-day ED visits. Standardized postdischarge communication may play an important role in improving quality and safety in the transition from hospital-to-home for vulnerable populations.
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Affiliation(s)
| | | | - Norah Emara
- From the Department of Pediatrics, Boston Children's Hospital
| | | | | | | | | | | | - Isabella Liss
- From the Department of Pediatrics, Boston Children's Hospital
| | - Phillip D Hahn
- Program for Patient Safety and Quality, Boston Children's Hospital
| | | | | | - Margaret V Thomas
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Nahel Elias
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Marie Morris
- From the Department of Pediatrics, Boston Children's Hospital
| | - Laurie Glader
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Amy Pinkham
- From the Department of Pediatrics, Boston Children's Hospital
| | | | - Sarah Wells
- From the Department of Pediatrics, Boston Children's Hospital
| | - Jayne Rogers
- From the Department of Pediatrics, Boston Children's Hospital
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Haspels HN, de Lange AA, Alsem MW, Sandbergen B, Dulfer K, de Hoog M, Joosten KFM, van Karnebeek CD, van Woensel JBM, Maaskant JM. Hospital-to-home transitions for children with medical complexity: part 2-a core outcome set. Eur J Pediatr 2023; 182:3833-3843. [PMID: 37338690 PMCID: PMC10570151 DOI: 10.1007/s00431-023-05049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/19/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023]
Abstract
Appropriate outcome measures as part of high-quality intervention trials are critical to advancing hospital-to-home transitions for Children with Medical Complexity (CMC). Our aim was to conduct a Delphi study and focus groups to identify a Core Outcome Set (COS) that healthcare professionals and parents consider essential outcomes for future intervention research. The development process consisted of two phases: (1) a three-round Delphi study in which different professionals rated outcomes, previously described in a systematic review, for inclusion in the COS and (2) focus groups with parents of CMC to validate the results of the Delphi study. Forty-five professionals participated in the Delphi study. The response rates were 55%, 57%, and 58% in the three rounds, respectively. In addition to the 24 outcomes from the literature, the participants suggested 12 additional outcomes. The Delphi rounds resulted in the following core outcomes: (1) disease management, (2) child's quality of life, and (3) impact on the life of families. Two focus groups with seven parents highlighted another core outcome: (4) self-efficacy of parents. Conclusion: An evidence-informed COS has been developed based on consensus among healthcare professionals and parents. These core outcomes could facilitate standard reporting in future CMC hospital to home transition research. This study facilitated the next step of COS development: selecting the appropriate measurement instruments for every outcome. What is Known: • Hospital-to-home transition for Children with Medical Complexity is a challenging process. • The use of core outcome sets could improve the quality and consistency of research reporting, ultimately leading to better outcomes for children and families. What is New: • The Core Outcome Set for transitional care for Children with Medical Complexity includes four outcomes: disease management, children's quality of life, impact on the life of families, and self-efficacy of parents.
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Affiliation(s)
- Heleen N Haspels
- Department of Pediatric Intensive Care Unit, Amsterdam Reproduction and Development, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Pediatric and Neonatal Intensive Care, Division of Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, 3015 CN, The Netherlands
| | - Annemieke A de Lange
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Mattijs W Alsem
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Karolijn Dulfer
- Department of Pediatric and Neonatal Intensive Care, Division of Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, 3015 CN, The Netherlands
| | - Matthijs de Hoog
- Department of Pediatric and Neonatal Intensive Care, Division of Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, 3015 CN, The Netherlands
| | - Koen F M Joosten
- Department of Pediatric and Neonatal Intensive Care, Division of Paediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, 3015 CN, The Netherlands
| | - Clara D van Karnebeek
- Department of Pediatrics and Human Genetics, Emma Center for Personalized Medicine, Amsterdam Reproduction and Development, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Job B M van Woensel
- Department of Pediatric Intensive Care Unit, Amsterdam Reproduction and Development, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jolanda M Maaskant
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
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de Lange A, Alsem MW, Haspels HN, van Karnebeek CDM, van Woensel JBM, Etten-Jamaludin FS, Maaskant JM. Hospital-to-home transitions for children with medical complexity: part 1, a systematic review of reported outcomes. Eur J Pediatr 2023; 182:3805-3831. [PMID: 37318656 PMCID: PMC10570194 DOI: 10.1007/s00431-023-05050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/19/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
Outcome selection to evaluate interventions to support a successful transition from hospital to home of children with medical complexity (CMC) may be difficult due to the variety in available outcomes. To support researchers in outcome selection, this systematic review aimed to summarize and categorize outcomes currently reported in publications evaluating the effectiveness of hospital-to-home transitional care interventions for CMC. We searched the following databases: Medline, Embase, Cochrane library, CINAHL, PsychInfo, and Web of Science for studies published between 1 January 2010 and 15 March 2023. Two reviewers independently screened the articles and extracted the data with a focus on the outcomes. Our research group extensively discussed the outcome list to identify those with similar definitions, wording or meaning. Consensus meetings were organized to discuss disagreements, and to summarize and categorize the data. We identified 50 studies that reported in total 172 outcomes. Consensus was reached on 25 unique outcomes that were assigned to six outcome domains: mortality and survival, physical health, life impact (the impact on functioning, quality of life, delivery of care and personal circumstances), resource use, adverse events, and others. Most frequently studied outcomes reflected life impact and resource use. Apart from the heterogeneity in outcomes, we also found heterogeneity in designs, data sources, and measurement tools used to evaluate the outcomes. Conclusion: This systematic review provides a categorized overview of outcomes that may be used to evaluate interventions to improve hospital-to-home transition for CMC. The results can be used in the development of a core outcome set transitional care for CMC.
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Affiliation(s)
- Annemieke de Lange
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mattijs W Alsem
- Department of Rehabilitation, Amsterdam UMC location University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Heleen N Haspels
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatric and Neonatal Intensive Care, Division of Pediatric Intensive Care, ErasmusMC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Clara D M van Karnebeek
- Department of Pediatrics and Human Genetics, Emma Center for Personalized Medicine, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction and Development, Meibergdreef 9, Amsterdam, the Netherlands
| | - Job B M van Woensel
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, the Netherlands
| | - Faridi S Etten-Jamaludin
- Medical Library, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jolanda M Maaskant
- Department of Pediatrics, Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, the Netherlands.
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Boerman GH, Haspels HN, de Hoog M, Joosten KF. Characteristics of Long-Stay Patients in a PICU and Healthcare Resource Utilization After Discharge. Crit Care Explor 2023; 5:e0971. [PMID: 37644970 PMCID: PMC10461958 DOI: 10.1097/cce.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES To examine the characteristics of long-stay patients (LSPs) admitted to a PICU and to investigate discharge characteristics of medical complexity among discharged LSP. DESIGN We performed a retrospective cohort study where clinical data were collected on all children admitted to our PICU between July 1, 2017, and January 1, 2020. SETTING A single-center study based at Erasmus MC Sophia Children's Hospital, a level III interdisciplinary PICU in The Netherlands, providing all pediatric and surgical subspecialties. PATIENTS LSP was defined as those admitted for at least 28 consecutive days. INTERVENTIONS None. MEASUREMENTS Length of PICU stay, diagnosis at admission, length of mechanical ventilation, need for extracorporeal membrane oxygenation, mortality, discharge location after PICU and hospital admission, medical technical support, medication use, and involvement of allied healthcare professionals after hospital discharge. MAIN RESULTS LSP represented a small proportion of total PICU patients (108 patients; 3.2%) but consumed 33% of the total admission days, 47% of all days on extracorporeal membrane oxygenation, and 38% of all days on mechanical ventilation. After discharge, most LSP could be classified as children with medical complexity (CMC) (76%); all patients received discharge medications (median 5.5; range 2-19), most patients suffered from a chronic disease (89%), leaving the hospital with one or more technological devices (82%) and required allied healthcare professional involvement after discharge (93%). CONCLUSIONS LSP consumes a considerable amount of resources in the PICU and its impact extends beyond the point of PICU discharge since the majority are CMC. This indicates complex care needs at home, high family needs, and a high burden on the healthcare system across hospital borders.
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Affiliation(s)
- Gerharda H Boerman
- Division of Pediatric Intensive Care, Department of Neonatology and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Heleen N Haspels
- Division of Pediatric Intensive Care, Department of Neonatology and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Pediatric Intensive Care Unit, Amsterdam Reproduction, and Development, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Transitional Care Unit Consortium, The Netherlands
| | - Matthijs de Hoog
- Division of Pediatric Intensive Care, Department of Neonatology and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Transitional Care Unit Consortium, The Netherlands
| | - Koen F Joosten
- Division of Pediatric Intensive Care, Department of Neonatology and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Transitional Care Unit Consortium, The Netherlands
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Diaz MCG, Arnold JL. Advocating for Your Patients and Families: Simulation as an Educational Tool for Home Caregivers of Children with Chronic Conditions. Pediatr Ann 2021; 50:e39-e43. [PMID: 33450038 DOI: 10.3928/19382359-20201215-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Simulation-based education for home caregivers of children with chronic conditions provides hands-on training set in a safe, confidential, supportive learning environment that is founded on the principles of patient-and family-centered care. This type of education and approach has been favored over traditional educational methods and may also improve caregivers' comfort, confidence, knowledge, skills, and ability to manage their child's routine and emergent care at home. Pediatricians play a vital role in this type of education as an advocate for their patients and families and as key stakeholders and collaborators in the process. Open collaboration and information sharing among home caregivers, simulation experts, pediatricians, and the rest of the medical team can lead to the development and implementation of successful simulation curricula. This in turn has the potential to lead to improved patient safety, quality of care, and patient outcomes. [Pediatr Ann. 2021;50(1):e39-e43.].
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