Pediatric Complexity Tool Best Practice Alert: Early Identification of Care Coordination for Children with Special Health Care Needs.

Care coordination programs continue to be developed for children with special health care needs (CSHCN). The goals for these programs are to improve access, increase communication, and decrease the overall length of stay for CSHCN. Care coordination optimizes resources to support children's health and well-being early in their hospitalization and facilitates a smooth discharge process and transition to home. Providing care coordination for CSHCN requires collaboration from many disciplines. To achieve high-quality care coordination, early identification of medically complex pediatric patients on admission is optimal. For more efficient and timelier enrollment into our care coordination program, we created a best practice alert within our electronic medical record to help overcome the challenges in timely identification of CSHCN. The best practice alert has helped us to provide care coordination benefits to our patients earlier in their hospital course. The purpose of this paper is to describe a quality improvement initiative to improve the early identification of CSHCN on hospital admission through the development of a best practice alert.

The Financial Impact of a Hospital-Based Care Coordination Program for Children With Special Health Care Needs.

Care coordination programs are important in caring for medically complex pediatric patients, particularly for children with special health care needs. This study is a retrospective financial analysis of a hospital-based care coordination program involving one procedural subgroup of children with special health care needs: those receiving pediatric tracheostomy. Hospital records were reviewed for patients who received a tracheostomy at a large Midwestern U.S. hospital from 1999 through 2015. The population was divided into two subgroups: patients who received a tracheostomy before the development of a care coordination program and patients who received a tracheostomy after enrollment in the care coordination program. Patient records were reviewed for length of stay, readmissions related to respiratory and tracheostomy management, and total hospital charges. Enrollment in a care coordination program for the pediatric tracheostomy patient resulted in a decrease in mean length of stay and reduced hospital charges and a slight increase in readmissions. Further analysis using larger sample sizes and multiple centers is necessary to determine whether such outcomes are the direct result of enrollment in a care coordination program.

Implementation and Evaluation of a Unit-Based Discharge Coordinator to Improve the Patient Discharge Experience.

Hospitals are currently focusing on quality measure initiatives such as patient safety, satisfaction scores, and patient length of stay. Inefficient and ineffective discharge planning is often directly associated with long hospital stays and poor patient satisfaction with the overall discharge process. The purpose of this quality improvement initiative is to describe and address the implementation and evaluation of a unit-based discharge coordinator role on a general medicine pediatric unit at a tertiary care children's hospital. Improved outcomes, including an increase in patient satisfaction with the discharge process, decreased length of stay, and a decrease in patient safety net reports are demonstrated through implementation. A unit-based discharge coordinator can play an important part in enhancing the overall discharge experience for the patient and families by providing an effective and efficient approach to discharge, providing the patients and families with a feeling of preparedness.

Development of a hospital-based care coordination program for children with special health care needs.

A hospital-based Continuity of Care program for children with special health care needs is described. A family-centered team approach provides care coordination and a medical home. The program has grown during the past 10 years to include inpatients and outpatients from multiple services and outreach clinics. Improved outcomes, including decreased length of stay, decreased cost, and high family satisfaction, are demonstrated by participants in the program. Pediatric nurse practitioners play an important role in the medical home, collaborating with primary care providers, hospital-based specialists, community services, and social workers to provide services to children with special health care needs.