Oral Themed Presentation
Preparing caregivers of children who are newly dependent on medical devices is a crucial part of the hospital discharge process. Many caregivers however, may not feel comfortable or confident to perform the necessary care for these devices. They may also be hesitant to be trained on their child for fear of causing harm during the learning process. Simulation-based Education (SBE) is a fast-growing field that can enhance existing patient education by creating a safe learning environment where crucial routine and emergency skills can be taught through enhanced teach-back prior to hospital discharge.
The Simulation-based Discharge Program (SDP) at the NewYork-Presbyterian Weill Cornell Medical Center Komansky Children's Hospital was developed through a joint effort of the Family Advisory Council (FAC) and an interprofessional committee of healthcare providers to provide SBE for caregivers of technology-dependent children. The two major components include: 1) SBE for caregivers based on an institutional standard of care on high fidelity patient simulators. 2) Parent-to-Parent support provided by the FAC members in person during SBE and via a HIPPA-complaint telephone platform for 6 months. FAC members are caregivers of children who were treated at our hospital and who partner with the hospital to improve quality, safety and patient experience. SDP is purposely designed to focus on the acquisition of basic skills in order to create an accessible and replicable program even for pediatric hospitals that might not have a strong simulation program.
SDP was initially developed for tracheostomy tubes and had so far trained 30 caregivers from 16 patients’ families. Based on demand, SDP is being expanded to include feeding tube training such as gastrostomy tubes and gastrojejunostomy tubes. Key elements of success in the tracheostomy program were replicated, including the formation of an interprofessional advisory committee to develop a standard of care, outreach to raise program awareness, partnering with hospital discharge coordinators to encourage caregiver enrollment, and continued partnership with the FAC by involving caregivers of children with feeding tubes to assist in the development of the Education Guide.
Lessons learned from the tracheostomy program had resulted in a number of key improvements, including a restructuring of the education guide format to match the process of day-to-day care and streamlining of the SBE process through trial runs with caregivers. The survey for self-reported comfort and knowledge and the objective skills assessment checklist were refined with more specific measures on key critical skills rather broad questions on the procedures. Due to difficulty with follow up, evaluation of retention is timed with established outpatient follow up schedules.
One of the key research goals of the feeding tube program is to leverage the larger patient population with feeding tubes to demonstrate the impact of SBE on outcomes-based measures such as reduction in device-associated complications, shorter lengths of stay, decreased ED presentations and readmissions. There are practical and ethical challenges in creating a study design that will provide an appropriate comparison group to demonstrate these outcome measures. Successfully demonstrating that simulation-based caregiver education programs like the SDP have a positive impact on patient outcomes will be the catalyst for more widespread adoption of SBE in patient and caregiver education.