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Complex Care Needs a Team Approach: How Implementation of a Nurse Key-Worker Can Improve Care for Children With
Tessa Diaczun1, Mimi T Y Kuan2, Tamara Crozier3
1UBC Faculty of Nursing, BC Children's Hospital, Vancouver, Canada.
Insights
A Nurse Key Worker (NKW) effectively coordinated care for children with medical complexity (CMC). This role improved family confidence and reduced healthcare system burden without needing more physician or nurse practitioner resources.
Area of Science:
- Pediatric Healthcare Delivery
- Complex Care Coordination
- Nursing Practice Innovation
Background:
- Children with medical complexity (CMC) require extensive, multi-sectoral support.
- Effective care coordination is crucial for CMC, as highlighted by Children's Healthcare Canada.
- BC Children's Hospital introduced a Nurse Key Worker (NKW) to enhance care coordination for CMC.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of the NKW role in coordinating care for families of CMC.
- To assess the specific activities undertaken by the NKW to meet care coordination needs.
Main Methods:
- Thirty-one caregivers of CMC participated in a 9-month study.
- Utilized electronic health records to track patient appointments pre- and post-NKW implementation.
- Administered caregiver surveys (Family Experience with Care Coordination Measure, PIHRE Self-Efficacy) and a clinician tool (Care Coordination Measurement Tool).
Main Results:
- A 45% increase in patient appointments was observed post-NKW implementation.
- Caregivers reported increased confidence and viewed the NKW as a reliable, single point of contact.
- NKWs addressed more care coordination needs (168) and activities (576) than physicians/NPs (115 needs, 282 activities), preventing unnecessary visits and reducing family burden.
Conclusions:
- The NKW role is effective in addressing the care coordination needs of CMC and their families.
- This role can be implemented without requiring additional physician or nurse practitioner resources.
- NKWs, NPs, and physicians perform distinct yet complementary activities in care coordination.
Background:
Children with medical complexity (CMC) have complex, chronic conditions and require specialized care and extensive support across multiple sectors. Children's Healthcare Canada guidelines highlight the importance of care coordination for this population. The BC Children's Hospital Complex Care programme introduced a Nurse Key Worker (NKW) to perform care coordination in conjunction with the expertise of physicians and nurse practitioner (NP).
Objectives:
To assess the feasibility of the NKW role in coordinating care for families of CMC. To evaluate the activities performed to meet care coordination needs.
Methods:
Thirty-one caregivers of CMC (0-19 years old) were invited to work with the NKW. Electronic health records were utilized to determine the number of patient appointments before and after NKW implementation. Caregivers completed the Family Experience with Care Coordination Measure and Patient-Reported Outcomes Measurement Information System Self-Efficacy tools at baseline and 9 months post-implementation. The physician, NP and NKW completed the Care Coordination Measurement Tool for a duration of 2 weeks to assess and quantify care coordination needs.
Results:
There was an average of 45% increase in the number of patient appointments after NKW implementation. Caregivers of CMC recognized their NKW as a reliable, skilled, single point of contact. More caregivers reported feeling "very confident" in their ability to care for their CMC. The NKW addressed 168 care coordination needs and performed 576 activities, whereas the NP and physician addressed 115 care coordination needs and performed 282 activities. The care coordination activities prevented unnecessary emergency and clinic visits and reduced family stress and burden.
Conclusion:
The NKW effectively addressed the care coordination needs of CMC and their families without requiring additional physician or NP resources. The NKW, NP and physician performed different activities to meet care coordination needs.
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