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Barriers and Facilitators to a Safe Discharge for High-Risk Children With Congenital Heart Disease
Deepika Thacker1,2, Jennie Ryan2, Varsha Zadokar1
1Nemours Cardiac Center at Nemours Children's Health, Wilmington, Delaware.
Insights
Parents/caregivers and healthcare personnel identified key factors for safe discharge of children with congenital heart disease (CHD). Their combined insights on communication, care complexity, and technology can improve care transitions for high-risk pediatric patients.
Area of Science:
- Pediatric Cardiology
- Health Services Research
- Qualitative Health Research
Background:
- Children with congenital heart disease (CHD) require complex post-discharge care.
- Parents/caregivers (P/CG) and healthcare personnel (HCP) face challenges during care transitions.
- Limited research comprehensively assesses dual P/CG and HCP perspectives on safe discharge for high-risk pediatric CHD patients.
Purpose of the Study:
- To comprehensively assess P/CG and HCP perspectives on factors influencing safe discharge for medically or socially high-risk children with CHD.
- To identify barriers, facilitators, and recommendations for improving discharge processes from both P/CG and HCP viewpoints.
Main Methods:
- Conducted semistructured qualitative interviews with 16 P/CG and 16 HCP involved in the care of high-risk pediatric CHD patients.
- Included P/CG of children with poor discharge outcomes (e.g., unplanned readmissions) and HCPs managing their care.
- Employed thematic analysis to code and analyze interview transcripts.
Main Results:
- Identified four key themes: teaching and communication, care complexity, P/CG presence, and technology utilization.
- For each theme, specific barriers, facilitators, and recommendations for enhanced support were detailed.
- Findings highlight the critical role of P/CG involvement and effective communication in safe discharges.
Conclusions:
- The experiences of P/CG and HCPs offer valuable insights into optimizing discharge processes for children with complex medical needs.
- Integrating dual perspectives can inform improvements in patient care and discharge planning for medically and socially high-risk pediatric populations.
- Collaborative identification of discharge factors can lead to safer transitions and better outcomes for children with CHD.
Objective:
Children with congenital heart disease (CHD) often require continued care after hospital discharge by parents and other caregivers (P/CG), many of whom report problems in the transition to home and outpatient settings. Few studies have comprehensively assessed the perspectives of both P/CG and health care personnel (HCP) to identify factors affecting a safe discharge for medically or socially high-risk children with CHD.
Methods:
Semistructured qualitative interviews concerning discharge processes and procedures were performed with 16 P/CG of medically or socially high-risk children with CHD (eg, receiving tube feeding) who experienced poor discharge outcomes (eg, unplanned 30-day readmissions) and 16 HCPs involved in their care. Interview transcripts were coded and analyzed using a thematic analysis approach.
Results:
Four themes were constructed from the qualitative data: 1) teaching and communication to promote a safe discharge, 2) complexity of care influences a safe discharge, 3) P/CG presence at the bedside facilitates a safe discharge, and 4) leveraging technology as a tool to promote a safe discharge. For each theme, barriers, facilitators, and recommendations for additional support were identified.
Conclusion:
Through their experiences, P/CG, as well as HCPs of children with complex medical conditions, can help identify barriers, facilitators, and recommendations for a safe discharge. Incorporating the perspectives of both groups has the potential to inform improvements in patient care and discharge processes for medically and socially high-risk children.
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