Characteristics of Pediatric Patients Admitted by Telehospitalist to Community Hospitals
Annalise Van Meurs1, Matthew Steinfeldt2, Nathan M Money3
1Division of Pediatrics, Kaiser Permanente Northwest, Portland, Oregon.
Insights
Pediatric telehospitalist care at community hospitals served diverse patient needs, including complex chronic conditions. This care model showed reasonable outcomes, suggesting feasibility for nighttime coverage.
Area of Science:
- Pediatric Hospital Medicine
- Telehealth
- Healthcare Delivery Models
Background:
- Increasing regionalization of pediatric inpatient care leads to longer travel distances for patients.
- Community hospitals face challenges in providing specialized pediatric care, particularly during off-hours.
Purpose of the Study:
- To describe the characteristics and outcomes of pediatric patients admitted by telehospitalists.
- To evaluate the feasibility of telehospitalist services in community hospital settings.
Main Methods:
- Multicenter retrospective cohort study.
- Involved pediatric patients admitted via telehospitalist at 2 community hospitals over 3 months.
- Collected data on demographics, length of stay, discharge disposition, safety events, and reutilization.
Main Results:
- 74 patients admitted; median age 3.5 years; median length of stay 1 day.
- Common diagnoses included bronchiolitis, asthma, suicidal ideation, and seizure activity.
- 19% of patients had complex chronic conditions; 88% discharged home; low rates of readmission (1%) and emergency department return (5%).
Conclusions:
- Telehospitalist admissions covered a range of pediatric diagnoses, including complex cases.
- Reasonable rates of care escalation and reutilization suggest telehospitalist services are a viable option for community hospitals.
- Telehospitalist care may be a feasible solution for ensuring adequate pediatric inpatient coverage, especially overnight.
Objective:
Pediatric inpatient care has become increasingly regionalized and dependent on large children's hospitals, causing pediatric patients to travel further distances for inpatient care. Our objective was to describe the characteristics and outcomes of patients admitted by pediatric telehospitalists to the pediatric units of 2 community hospitals.
Methods:
This was a multicenter retrospective cohort study among pediatric patients admitted via telehospitalist at 2 community hospitals over a 3-month period. Descriptive data collected included demographics for each patient, length of stay, discharge disposition, safety events, and reutilization.
Results:
Seventy-four patients were admitted by telehospitalist providers during the study period. Median (IQR) age was 3.5 (1.0, 12.8) years. Median (IQR) length of stay was 1 (1, 2) day. The most common diagnoses for admitted patients were bronchiolitis (23%), asthma (15%), suicidal ideation (12%), and seizure activity (7%). Sixty-five (88%) patients were discharged home, and seven (9%) were discharged to a psychiatric facility. Two (3%) patients were transferred to a higher level of care. Four (5%) patients returned to the emergency department within 30 days, and one (1%) was readmitted. Fourteen (19%) patients had complex chronic conditions, which were most commonly neuromuscular/neurological, metabolic, and neonatal conditions.
Conclusions:
Children admitted by telehospitalist comprised a variety of diagnoses, and nearly 1 in 5 had at least 1 complex chronic condition. Patients admitted by telehospitalist had reasonable rates of care escalation and reutilization, suggesting that this may be a feasible option for community hospital nighttime coverage.
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