Aim To evaluate the effect of targeted consultant time in sharing mental models with parents and nursing staff for children with medical complexity (CMC).
Background CMC are part of a mixed caseload covered by the acute paediatric team. We define them here as children with a length of stay ≥ 7 days with ≥ 2 system involvement. Feedback shows these children experience prolonged length of stays (LOS) with a need for coordination of care often between different teams. Parents have highlighted that that better communication with them, within teams and between different teams could improve their child’s journey.
Methods All team members were briefed using written and verbal communication as were parents and children taking part. Patients were allocated a weekly slot over a four week period to meet with the MICMAC consultant and a member of the nursing team. Sharing of mental models was facilitated using a targeted proforma covering current expectations and barriers to discharge. The MICMAC consultant was briefed by the service team prior to the meeting and handed back afterwards. Qualitative feedback was obtained using structured debriefing interviews with ward managers and parents. Group debriefing sessions were carried out with the junior medical team and the consultant body covering key themes highlighted by the parental feedback.
Results A total of 12 patients with an average LOS of 90 days (range 13–241) over 6 wards were included. 11 consultants led a total of 34 meetings. 3 children were discharged home and 2 patients had withdrawal of care. A total of 6 nursing manager interviews and 9 parental interviews and one substituted lead clinician interview were undertaken. Debriefing of the medical teams was undertaken in 2 group sessions. Positive feedback was centred around improved coordination of care, understanding of overall direction and sharing of information.
Conclusions The CMC group is recognised as an expanding patient group. Key factors influencing their inpatient journey involve communication between caregivers and the responsible teams. We highlight how a simple targeted communication tool can improve quality of patient journey.
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