My son was born at 28 weeks gestation and then spent 99 very long days in the NICU. It wasn’t until we had been home for several months that I started to process the trauma and isolation I experienced throughout his NICU stay. I survived his hospitalization by developing a fight or flight mindset in an effort to protect myself… I focused on every detail of his daily care and, at the time, failed to recognize how abnormal our overall experience was. As a NICU nurse myself, I openly had very high expectations.. I set boundaries for myself with the hopes of not becoming an overbearing, difficult parent…
Over the years, I have had the opportunity to provide emotional support to many mothers whose babies were admitted to the Neonatal Intensive Care Unit (NICU). As a NICU nurse, I would recite the same comforting words to each mother as she was discharged and forced to leave the hospital without her newborn. It was not until I had to leave my 28-week son, Theo, in the NICU that I fully understood the trauma of being physically separated from him. I was just starting to mentally and physically comprehend that I was no longer pregnant when I was discharged home on his sixth day of life. As I was wheeled through the lobby to go home, I sobbed as I held my empty, tender belly, longing to feel his gentle kicks again. Leaving the hospital without him was the most unnatural, painful, and confusing experience I have ever endured.
I couldn’t work around sick babies. I don’t know how you do it.” The infamous statement every neonatal professional has heard. Like many NICU nurses, I was called to this field of nursing before having babies of my own. For many years, I dreamed of having a baby; although, the thought of carrying a baby for nine months was terrifying.
It is the goal of all hospitals to make our patients and our communities healthier. As part of that, hospitals must become trusted partners in their patients’ pursuit of health and wellness. This begins with education. And when the patient is a child in the NICU or PICU, education becomes especially important for parents and families. From the moment a child is admitted to the NICU or PICU, parents need to feel as though their providers will go above and beyond to keep them informed and engaged.
To achieve this goal, hospitals must design and implement a comprehensive, parent, and family education program. But some hospitals don’t have the resources—staff, time, nor money—to focus on building this type of program. Such hospitals, along with those looking to enhance an existing program, can benefit by partnering with industry experts to help develop and maintain educational resources for parents and families of children in critical care units. When looking for a partner, hospitals should choose ones with the following capabilities.
Provide an online portal for easy access. Providing parents and families with paper-based educational materials is good, but the paper is easily misplaced or lost. Having the information available online helps ensure it is accessible when and where it’s needed from any internet-enabled mobile device. The portal should be available to parents and families from the moment of their child’s admission.
Offer a comprehensive document library. It is not uncommon for parents to “google” their child’s condition or care procedures, but the information they find may or may not be appropriate for the child’s specific situation. Having a single easy-to-navigate library of all pertinent information increases compliance and helps improve satisfaction as parents aren’t left to go searching for the information they need on their own.
Provide customizable educational materials. Canned educational materials can be sufficient in some cases. But for parents with children in the NICU or PICU, it is essential they have access to information customized for the child’s condition or procedure. This can reduce confusion, increase comprehension, and improve compliance and care experience.
Offer educational videos. Written information with heavy detail can be overwhelming for parents. Educational videos can improve clarity and retention.[1] This can be especially effective for parents and extended family caregivers.
Enable pre-recorded, personalized videos. For more complex procedures, it can be beneficial for the hospital to record instructions with the actual child and parents before discharge. This allows more child-specific instructions, which can reduce anxiety, increase compliance, and improve outcomes.
Provide access to all family members. The rehabilitation period for children who have been under critical care can be lengthy. In these cases, it is likely that more than one family member will be helping care for the child at home. And those family members need easy access to all educational materials. They shouldn’t have to rely on others to provide the information they need.
Make materials available for the full recovery period. As time passes or caregivers change, it is easy to forget details about the care plan. Rather than guessing, caregivers need to be able to access the information they need for the full length of the recovery period. This helps improve care plan compliance and outcomes.
Enable reporting and tracking. Once a child has been discharged from the hospital, it is impossible to know if parents are following care instructions. The best educational solutions provide hospitals with the ability to track how often educational materials have been accessed and by whom. Having this information helps inform outpatient caregivers of potential compliance issues and can assist them in preparing for follow-up calls and appointments.
The Bottom Line
Studies show that when care plan instructions are understood at the time of discharge, patients are 30% less likely to be readmitted or to visit the ER.[2] Partnering with a solutions provider to design a comprehensive education program for parents with children in the NICU or PICU can significantly impact quality outcomes and the care experience, both of which drive revenue, improve a hospital’s reputation in the community, and generate a healthier bottom line.
Millions of children are admitted to intensive care units each year for critical conditions, accidents, or surgeries. Besides the physical pain, the experience can cause emotional trauma as well. The fear, anxiety, and shock can be overwhelming for patients and their families. Often many families struggle with a sense of frustration and helplessness. Studies show that when parents and families are more educated about their child’s health conditions and care plans, they take a more active role in that care.
Millions of people enter the hospital each year for critical conditions, accidents, or surgeries. Besides the physical pain, the experience can cause emotional trauma as well. The fear, anxiety, and shock can be overwhelming. The patient’s family often struggles with a sense of frustration and helplessness. For families of neonates in NICUs, those feelings can be even more profound. Relieving these emotions requires hospitals to have a comprehensive program for educating patients and their families about the patient’s condition and care plan, providing as much detail as possible throughout the entire episode of care. But far too often, that doesn’t happen.
It’s not hard to remember a time when patients and their families were kept in the dark about what was going on. “Doctor knows best” was the motto and patients and their families just had to blindly trust the providers were doing what was best for the patient. But studies now show that patients who are more educated about their health conditions make better decisions about their care. And when patients and families make better decisions, it increases care plan compliance, a critical element for achieving quality outcomes.[1]
Post-discharge patients are 30% less likely to be readmitted or to visit the ER if they understand their care plan instructions.[2]
Yet even with this research, many hospitals and health systems still do just the minimal in the way of patient and family education. Whether due to a lack of resources, poor supervision, or just a weak culture, when hospitals don’t see value of sharing knowledge, patients suffer.
Designing an Educational Program
Following are three actions hospitals can take to begin designing a comprehensive education program for patients and their families.
Increase access to information. Transitioning from an acute care environment to the home can cause a great deal of anxiety, especially for patients who were being treated in a critical care unit or for their family caregivers. Between the time the patient receives discharge instructions to the time the patient arrives home, a lot of information can be forgotten. The result can be confusion on things such as when to change a dressing or how often to take medication. The latter is especially problematic as studies show that up to 40% of patients over 65 experience medication errors after discharge.[3] The same study found that 18% of Medicare patients are readmitted within just 30 days after discharge due to complications. Patients and their families need a way to easily access that information whenever and from wherever they need it. Paper instructions can get lost or misplaced and verbal instructions can be misunderstood and easily forgotten. Having ready access from a mobile device or desktop gives patients and their family added confidence that they have the information needed to manage at-home care.
Create an online educational resource center. In the same vein as having access to information when and where they need it, patients need that information to be comprehensive, yet easy to understand. Documentation should be available to print for patients who prefer to have a physical copy of instructions. Information should be specific to each patient’s unique condition and care plan needs. If you don’t want to customize to each patient, you should at least customize to the condition. You also want to make sure the information is accessible my family members and that it’s available for as long as the patient is in recovery at home.
Providers and case managers should be able to view which documents or videos have been viewed and by whom. If a patient hasn’t viewed any documents, this may be a red flag for non-compliance. Caregivers can schedule follow-up calls to address any concerns or questions that may arise.
Create educational videos. Video has now become the format of choice for many educational programs, primarily because people retain more of what they learn.[4] Reading step-by-step static instructions on a piece of paper can be confusing. But showing those same instructions in a video helps the patient or family member better understand the procedure. Even more beneficial is taking the video with the actual patient in the hospital setting prior to discharge. This can be especially effective for things like enteral feeding or treating wounds.
A Key Part of Your Quality Initiatives
Achieving and maintaining key quality criteria has a direct impact on a hospital’s HCAHPS scores, not to mention its long-term viability. And having a comprehensive education program for patients and their families is an essential part of that effort. Educated patients make take a more active role in their own health and are more likely to stay in compliance with their care plan. Hospitals benefit through better outcomes, increased reimbursement, and improved patient satisfaction.
An article published in the Baylor University Medical Center Proceedings stated, “In the context of escalating health care costs and shocking future cost projections, the potential for improved health outcomes through patient education and self-management programs is immense.”[1] At the heart of this idea, according to the authors, is patient engagement.
Nowhere is this more true than in the Neonatal Intensive Care Unit (NICU) where research indicates parental involvement and communication are key to positive outcomes.[2] And this communication should extend beyond the walls of the hospital and beyond patient discharge. Babies that have been in the NICU have higher rates of readmissions than other infants.[3]
Following are five elements hospitals should include when developing an educational program for NICU parents and families.
How-to videos. People generally retain more information when watching a video than they do just reading documents. Videos also offer the ability to show real-life examples of more complex at-home care instructions. For parents of neonates, watching a “how-to” video can ensure they’re following appropriate care procedures. It can also increase the parents’ confidence in their ability to properly care for their infant at home.
Condition-specific Information. Not all NICU graduates require the same level of at-home care. It is important that parents have access to educational information customized to their infant’s specific condition. This helps reduce anxiety and improve peace of mind. And because parental stress has a direct impact on a baby’s development, providing this peace of mind is important for improving outcomes.[4]
Virtual access. Leaving the hospital with a handful of care documents gives parents the feeling that they’re on their own to sink or swim. By offering them 24/7 access to an online library of educational information after discharge gives parents the ability to find the information they need when and where they need it. Because an online library can be accessed from any internet-enabled device, parents can find information faster and easier.
View tracking. Adherence to care plans is essential to reducing readmissions and complications. Having the ability to track whether parents are accessing information and which information they’re accessing can help clinicians identify families that may be struggling. It also helps clinicians better prepare for follow-up calls and appointments.
HIPAA compliance. Personal healthcare information is a very valuable commodity on the black market. Hospitals need to ensure any PHI is protected at the highest level. This means personalized educational materials need to be behind secure logins and housed on industry-certified web servers.
Bringing home a baby who has been in the NICU for weeks or months can be overwhelming for parents. They may be apprehensive about their ability to care for the special needs many neonates require. By providing educational materials in multiple formats both inside the hospital and post-discharge, hospitals can help relieve parental anxiety, increase adherence to ongoing care plans, and improve outcomes.
One of life’s greatest joys is having a baby. However, when the baby is born prematurely, that joy can be overshadowed by anxiety and stress. On top of the concern for the baby’s health, parents can feel overwhelming insecure about leaving their newborn in the hospital. Especially while getting back to their normal life routines, particularly when the stay extends for weeks or months. And they have good reason to be concerned. When parents are actively engaged, neonates experience better outcomes.
Babies exposed to maternal sounds in the NICU experience fewer cardiorespiratory events.[1]
Preterm babies exposed to parental talk achieve higher language and cognitive scores at 7 and 18 months.[2]
Exposure to parental talk is a strong predictor of infant vocalizations.[3]
Increasing access to the NICU for parents and families should be considered an essential part of a neonatal care program. It is often difficult for parents to travel to see their little ones. All hospitals with neonatal ICUs can relieve this stress by leveraging virtual engagement technology.
Bedside web cameras
Studies show a link between postpartum maternal distress and adverse cognitive, behavioral, and psychomotor development in infants. Web cameras placed at the bedside can help relieve this stress by allowing parents to view their infant at any time from a web-enabled device. With audio capabilities, the parent can verbally interact with the baby as well. In addition to helping the mother and father, it also provides the infant with the health advantages of parental talk, even though they aren’t physically present.
When choosing a web camera technology, look for one that allows parents to view multiple babies with the same login. Choose those that are easy for staff to use and that provide staff with multiple views on a single screen. Consider solutions that offer the ability to easily reposition the camera without having to log into the system to verify the change. While 24/7 viewing is optimal, there may be times when the camera needs to be turned off for privacy. Look for a solution that offers a bedside switch. Integration with the EMR and bed management system is also important.
Clinical communication
Technology can support communication between the care team and family, increasing trust and making the process more efficient. Video technology is great for capturing clinical updates or rounds when parents are unable to be present. The videos can be used internally to improve clinician-clinician communication. Sharing information becomes easier and helps improve patient hand-offs while reducing gaps in care. Beyond improving internal workflows, videos can be shared with parents to help provide additional information captured in real-time that may be overlooked during a phone conversation.
When choosing video technology, look for high-resolution and superior audio quality. Lower quality solutions may be cheaper, but they can be confusing if the information presented in the video can’t be understood. Be sure to ask if video storage is HIPAA compliant and for what timeframe videos are accessible and by whom.
For many NICUs, the primary form of communication with families is the phone. This is especially true when the parents live in a rural area where traveling to the hospital is difficult. Virtual tools such as interactive text can help improve information-sharing and reduce phone calls, leaving clinicians more time to focus on direct patient care.
The best virtual communication solutions provide a variety of features such as one-way messages pushed similar to text, as well as photo and video updates, and family message boards. Another great feature is Google Translate, which translates more than 100 languages, helping to improve communication and accuracy of information shared. It also helps make communication between the staff and the family more efficient. Patient satisfaction surveys provide an added benefit by being able to capture family feedback easily. This real-time feedback can be invaluable for driving quality improvements in the NICU.
Online education
When most neonates leave the hospital, they continue to require specialized care. This can be overwhelming for parents and family caregivers. Providing them with the resources they need can go a long way in reducing their anxiety and improving adherence to care plans. Education is also important for reducing readmissions and achieving the best long-term health outcomes. Having educational tools available 24/7 can help ease the transition from hospital to home for both the infant and the family.
Look for solutions that provide an easy-to-use platform that can be accessed on a desktop as well as a mobile device. It should have multiple logins so that each family member caring for the infant can easily access the information they need when they need it. Documentation should be customizable to the infant’s specific condition and should be provided in a user-friendly library format. In some cases, videos can provide more detailed guidance than documentation. Look for solutions that offer both pre-recorded videos and the ability to record videos in real-time. It’s also helpful to have a solution that allows clinicians to validate which materials have been viewed. This enables clinicians to conduct more informed follow-up calls to ensure compliance or to address concerns.
Relieving stress. Improving outcomes.
We are achieving remarkable advancements in the care of premature and high-risk neonates. Unfortunately, this often results in longer stays in the NICU and longer separation between infants and their parents and family. By leveraging technology-enabled virtual engagement solutions, hospitals can enhance the patient, parent, and family experience while improving health outcomes.
The New Role of Virtual Care Technology in Removing Barriers and Improving Connectivity Between Providers, Patients, and Families
Access to quality care is one of the major challenges facing our healthcare system today. Rural areas—home to one in five Americans—are particularly hard hit as hospitals and other clinical resources leave smaller communities in an effort to consolidate operations and lower costs. This means millions of consumers nation-wide have to travel—sometimes for hours—to receive care. This is especially troublesome for pregnant women or those with chronic conditions.
But there’s another aspect of care access that may be under the radar of most people. And that’s the lack of access to, and connectivity between, caregivers, patients, and their families. This is especially true in situations where the patient is in a critical care unit. A great example is the case of a premature baby. While infants often have to remain in the NICU for months, parents have to get back to their lives. Whether to return to a job or to take care of other children at home, it can be emotionally challenging for them to leave their newborn. The lack of real-time connectivity can increase anxiety, which increases calls to the hospital for updates.
Whether separated by distance or other circumstances, the solution is the same: virtual care technology.
Consumerism
There are many factors driving virtual care, with consumerism at the top of the list. Now that patients owe more of their own healthcare costs, they’re demanding more control, more access, and more timely information—all things that can be addressed through virtual care technology. A 2017 patient survey found that 60% of consumers would take advantage of virtual care and 20% would actually change providers for the ability to do so.
Value-based care
Another driver of virtual care is value-based care. In the fee-for-service era, there was little thought given to the idea of a continuum of care. Each patient visit was treated as a separate event. Hospital readmissions—whether related to the visit or not—was seen as a separate event as well. With value-based reimbursement, that mindset is detrimental to a hospital’s financial stability. Episodes of care are now connected, which means the patient’s caregivers need to collaborate in new ways. Virtual care is a key enabler of that collaboration. In addition to the financial aspect of collaboration, virtual care is now proven to increase quality outcomes.
Virtual care in action
AngelEye Health, a leading provider of virtual engagement solutions for NICUs, PICUs, ICUs and Surgery is removing physical barriers that often separate patients, families, and providers, allowing real-time interaction throughout the continuum of care. The AngelEye Camera System extends engagement beyond the hospital walls by allowing parents of children in the NICU to keep an eye on their child throughout their stay via a live feed from a bedside camera.
The company’s Virtual Care Platform allows parents and family members to view or speak to the patient in real-time, which can be comforting to the baby and give parents greater peace of mind. The solution acts as a virtual network between providers, patients, and families, enabling better communication, decision-making and overall care. Providers can send real-time updates to parents via text, video or pictures, and patients can access a virtual library of educational materials and “how to” videos to help improve care after discharge and prevent readmissions.
For providers, virtual care technology gives them the ability to record and store daily rounding videos, which helps remove silos of information while streamlining workflows. Providing a seamless care experience that extends beyond the hospital walls and post discharge improves patient satisfaction and helps increase HCAHPS and Press Ganey scores.
Removing barriers for better care delivery
Patients today demand better communication and more accountability from the providers who treat them and their loved ones. This may explain why malpractice costs and national claims have risen by 57%.
Virtual care technology enables parents and families of critical care patients to engage with their loved ones, along with providers, both inside the hospital and out. Solutions like AngelEye can help. Patients and families gain peace of mind through rapid, visual access, while hospitals enhance communication across the care continuum, increasing patient satisfaction, improving outcomes, and reducing readmissions.
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It is the goal of all hospitals to make our patients and our communities healthier. As part of that, hospitals must become trusted partners in their patients’ pursuit of health and wellness. This begins with education. And when the patient is a child in the NICU or PICU, education becomes especially important for parents and families. From the moment a child is admitted to the NICU or PICU, parents need to feel as though their providers will go above and beyond to keep them informed and engaged.
