Children's Hospital at Montefiore, Bronx, New York, USA.
Department of Epidemiology & Population Health Division of Biostatistics, Albert Einstein College of Medicine, Bronx, New York, USA.
Pediatr Blood Cancer. 2023 Jan;70(1):e30045. doi: 10.1002/pbc.30045. Epub 2022 Oct 10.
We sought to improve caregiver retention of critical initial hospital discharge instructions using a multidisciplinary, team-based intervention for newly diagnosed pediatric cancer patients at high risk for unfavorable outcomes.
A multidisciplinary team of pediatric residents, nurses, social workers, pharmacists and hematology/oncology faculty implemented practices to optimize teaching of key discharge material as part of four Plan-Do-Study-Act intervention cycles. An 11-question survey distributed at the first post-discharge clinic visit assessed the efficacy of the intervention, as defined by caregiver retention of critical home instructions.
Thirty-nine caregivers of pediatric cancer patients in an urban academic tertiary-care children's hospital took part in this project. Overall retention of key discharge information was greater in the post-intervention cohort compared to the baseline cohort (median total scores: 89 and 63, respectively; p = .001). Improvements in the proportions of correct responses post-intervention were also observed across all subject matters: from 0.57 to 0.88 for fever guidelines (p = .059), from 0.71 to 0.78 for signs of sepsis (p = .65), from 0.57 to 1.00 for accurate choice of on-call number (p = .004), and from 0.71 to 0.94 for antiemetic management (p = .14).
Initiation of our comprehensive cancer-specific program to improve caregiver retention of discharge instructions at the first post-hospitalization clinic visit has been successful and sustainable. This project demonstrated that a multi-disciplinary collaborative team effort increases caregiver retention of critical health information, and this has potential to lead to improved outcomes for patients.
我们旨在通过针对患有儿科癌症且预后不良风险较高的新诊断患者的多学科团队干预措施，提高照护者对关键初始出院医嘱的保留率。
由儿科住院医师、护士、社会工作者、药剂师和血液学/肿瘤学教师组成的多学科团队实施了各种实践，以优化关键出院材料的教学，作为四个计划-执行-研究-行动干预周期的一部分。在首次出院后门诊就诊时发放的 11 个问题调查问卷评估了干预措施的效果，其定义为照护者对关键家庭医嘱的保留率。
在这项城市学术性三级儿童保健医院的研究中，共有 39 名儿科癌症患者的照护者参与了该项目。与基线组相比，干预后队列中关键出院信息的保留率更高（中位数总分分别为 89 和 63，p=0.001）。干预后，所有主题的正确回答比例也有所提高：从发热指南的 0.57 提高到 0.88（p=0.059），从脓毒症迹象的 0.71 提高到 0.78（p=0.65），从正确选择随叫随到号码的 0.57 提高到 1.00（p=0.004），以及从止吐药管理的 0.71 提高到 0.94（p=0.14）。
在首次住院后门诊就诊时，我们启动了全面的癌症特定项目以提高照护者对出院医嘱的保留率，该项目是成功且可持续的。该项目表明，多学科协作团队的努力可以提高照护者对关键健康信息的保留率，这有可能改善患者的预后。
