It’s been ten years since Christopher Baker, MD, and the interdisciplinary Ventilator Care Program team embarked on a journey to reduce the burdens associated with caring for ventilator-dependent children post tracheostomy. Given the program’s success—length of stay has been reduced by 42% and direct hospital costs were reduced by 43%—the team is now expanding the ways they can help caregivers and patients. This includes using telemedicine to enhance the service they provide to their families.
The program began informally in 2006 with pulmonology and neonatology working together to standardize the discharge process. Prior to this intervention, length of stay was often many months and even years for the most complex patients.
“Once we started mapping the process, we realized we were basically reinventing the wheel each time a patient was ready to go home,” said Dr. Baker, co-founder and medical director of the Ventilator Care Program at Children’s Hospital Colorado.
The team hypothesized that by standardizing the process, they could reduce length of stay and costs. Of course, safety was always the first priority.
“Every child in our care still receives a completely customized care plan, but the path each follows to discharge is now largely the same,” he said.
Mapping the process allowed the team to develop the Chronic Ventilation Road Map for caregivers—a chart that looks a lot like a board game that shows the various steps a patient has from the ICU to the Pediatric Respiratory Care Unit to home. Each step represents an aspect of care that caregivers need to master, from feeding to CPR to medication administration. As caregivers travel along the map, the team tracks patient and caregiver readiness for discharge and coordinates any additional care required once the patient moves back home.
“It’s competency based education,” said Dr. Baker. “It focuses on the person understanding and demonstrating their skills.”
Another part of caregiver education involves high fidelity simulation where the Children’s Hospital Simulation Lab is converted to look just like a patient’s room at home. There, they simulate two emergency scenarios that caregivers could face.
“We’ve had patients tell us that this level of simulation really helped when something urgent happened at home,” he said.
The team provides care to patients and families in a seven state region, so exploring options to expand care through telemedicine has become a focus.
“These kids are difficult to transport. In the winter, families are required to drive over mountain passes and through high altitudes,” he explained. “We don’t really want these kids making long road trips to come to the hospital.”
The team recently engaged in a telemedicine pilot project for patients who live near Colorado Springs. They were able to decrease transport time and miles driven by 70%. In these virtual visits, they’ve been able to use a Bluetooth stethoscope to perform remote auscultation.
“The high quality of the video allows the visits to feel personal—we can talk and move the camera to ensure a good look at the ventilator and its settings.”
But having virtual clinics in other cities isn’t foolproof with Colorado’s fickle weather. “There was one day where we had four patients scheduled for telemedicine, but didn’t see any of them because of a snowstorm—and they all just lived across town.”
Dr. Baker explains that their team is currently working closely with the telehealth team at Children’s Colorado to work through licensing and reimbursement issues in order to expand their reach.
“Our ultimate goal is to get to the point where we can see these kids at home,” he explains. “These virtual housecalls will be a win for everyone involved.”
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