Kristina Garne Holm

Neonatal tele home care – a new service for premature babies and their families

Kristina Garne Holm, cand.cur., PhD student, kristina.holm@rsyd.dk

Background

Preterm birth is associated with a long hospitalisation of the infant in the neonatal unit.

300 preterm infants were admitted in the H.C. Andersen Children’s Hospital during 2014 and in total they spent 5582 days in the hospital.
Mothers are admitted with their infant. The last weeks until discharge mainly concerns tube feeding and breastfeeding establishment, which is a prolonged process that can’t be forced, because it depends on infant maturity.

During that process parents can become impatient as they are longing to be a family in their own home. Furthermore, some mothers start to bottlefeed the infant instead of breastfeeding hoping for earlier discharge. Infants are discharged when able to eat all the food necessary for weight gain from breast or bottle, without supplemental tube feeding.

Odense University Hospital has now initiated a study to develop and implement a solution which will give the families more freedom and flexibility, and hopefully also improve on the use of resources and patient flow in the hospital.

 

The telemedicine serviceMit Forløb Neonatal (2)

The families who participate in the project are discharged as soon as the baby is stable and in no clinical danger. In their home they receive support from the clinical staff from the Neonatal Department by video consultations on an iPad provided by the hospital.

On the iPad is the patient communication app “My OUH journey” that contains information about prenatal care, instruction videos and the possibility to communicate with the hospital staff through messages and by sending pictures of the baby to them. The videoconsultations are also facilitated through the app. The app also contains a nourishment schedule or plan which is sent to the families twice a week. Through this plan provided by the health professionals, the parents always know how much food, protein and vitamines their baby has to take each week as it grows.

The patient app is developed at Odense University Hospital and is seamlessly integrated with the electronic medical record which makes it easy for the hospital staff to view information, answer messages – and record it all in the official patient records.

Twice a week the parents and hospital staff have a video consultation to ensure that they baby is healthy and growing as it should. As an extra precaution, the child is checked by a doctor in the hospital once every two weeks.

If an acute situation arises, the families can also call the department or go the hospital any time at day or night. This way, the mother is supported by the hospital to get started with breastfeeding and begin life with her new child without having to spend weeks in a hospital bed away from the rest of the family.

 

Status on the project

The first families started using the telemedicine service in November 2015, and in the last year more than 90 premature babies and their mothers have been “home-hospitalised” with telemedicine – and the demand for the service by the mothers have been quite high once they started hearing about the possibility.

Both parents and hospital staff are very satisfied with the solution so far. The families feel safe and supported, and they enjoy the freedom to be in their own home that the solution offers. The staff are also happy with the solution as they still feel able to give the proper care and support to the babies and parents.

 

About the PhD study

The PhD project was initiated in the spring of 2015 and lasts for three years.

The aim of this study is to test and evaluate if preterm infants can be hospitalised at home on an Early Home Program (EHP) with the use of telemedicine during the weeks of tube feeding and breastfeeding establishment.
Theories of family centered care and parent empowerment will be involved in the study. An EHP programme with telemedicine for preterm infants have not previously been studied, therefore Participatory Design (PD) will be used as an overall theoretical frame for the development of the telemedicine solution.
PD is a process where users are involved when new technology is to be developed focusing on creating connections between theory, research and daily clinical practice. Qualitative methods as interviews, focus group interviews and observational studies will be used. Further quantitative methods as questionnaires and data from hospital medical records will be obtained.

 

First phase of the study concerns covering the needs of parents, nurses and doctors when infants are on an EHP program with telemedicine.

Second phase is developmental. Based on the results from the first phase, the telemedicine solution will be developed, then tested in the hospital, then between hospital and infant homes to ensure safe technology.

Third phase is a pilot test where a minimum of 50 preterm infants will be hospitalized at home on the EHP program with telemedicine. During the pilot study data concerning infant health and nutrition will be obtained. Parents will be interviewed concerning experience and satisfaction regarding the EHP program, likewise with nurses and doctors.

 

Main supervisor

Jane Clemensen, adjunct professor, Ph.d., Head of clinical research at Centre for Innovative Medical Technology, Odense University Hospital.

Co-supervisors

Gitte Zachariassen, chief physician, neonatologist, PhD, clinical adjunct professor, H.C. Andersen Children’s Hospital, Odense University Hospital.

Anne Brødsgaard, clinical researcher, external adjunct professor, PhD, Children’s Ward, Hvidovre Hospital.

 

Permanent link to this article: http://old.cimt.dk/research/phd/kristina-holm/