Healthcare News & Insights

Strategies to improve children’s health after discharge

It’s important for providers to communicate information about recovery to patients and their families – but it’s even more critical for the youngest patients who can’t advocate for themselves. New research suggests providers must do more to educate parents about how to properly care for children after a hospital stay. 

According to research published in Pediatrics, many parents and guardians aren’t entirely clear on their child’s discharge instructions. These knowledge gaps can have serious consequences for children, including multiple readmissions.

While much of the focus has been on reducing Medicare readmission rates, it’s also necessary to look at the rates for children as well. In an era of value-based reimbursement, hospitals must work to improve patient outcomes and avoid complications for patients of all ages.

Common errors with children’s care

To see how often miscommunication between parents and providers caused issues, researchers from NYU’s School of Medicine and Bellevue Hospital Center looked at data from multiple studies about patient care.

Per an article from Reuters, parents struggled the most with making medication errors after their children left the hospital. Errors where parents administered the wrong dose of medication (either too much or too little) were common, occurring up to 48% of the time. Most of these issues happened with liquid medications.

Close to 38% of parents and guardians weren’t aware of the right dosage for their child’s medication at all, and nearly 42% didn’t know how often children needed to take their prescriptions.

Even worse: Almost a third of low-income families never even picked up their child’s prescription.

Many parents also weren’t clear on what follow-up appointments were required for their children after discharge. Up to 62% of families didn’t make the recommended follow-up appointments with a primary care physician or other provider once children left the hospital. Rates were worse for children who visited the emergency department: Nearly 81% of them never scheduled a follow-up visit.

Reasons varied for missed appointments. Besides lack of knowledge on their necessity, parents were likely to miss these appointments if they didn’t have private health insurance, had more than one child, or had trouble speaking English. Another barrier was if they found it difficult to miss work or take a child out of school to visit the doctor.

Additionally, they didn’t know how to look for the signs that a child’s health was worsening and needed immediate medical attention. This, combined with a lack of follow-ups, often led to a readmission or a visit to the ED.

The situation could be even worse than the study implies. Most data came from discharges that took place during the daytime hours. Little information was available for children who left the hospital during evenings and weekends. Because clinical staff are more tied up on weekends and evenings, families may not get as many opportunities to ask for clarification and help before discharge.

Solving problems

Instead of waiting for parents or guardians to ask about their responsibilities upon a child’s discharge, providers should take the initiative to keep them informed as soon as a hospital stay begins. If clinicians are proactive, children’s outcomes significantly improve.

Example: Children were more likely to attend follow-up appointments if providers helped families schedule them before discharge. It’s also helpful if providers discuss any potential barriers to keeping appointments (e.g., lack of adequate transportation) before young patients leave the hospital, so clinicians can suggest alternatives.

Similarly, medication mistakes declined when providers specifically made it a point to show parents and guardians exactly how to measure and administer the drug, including the proper way to fill syringes or medicine cups.

Misunderstandings decreased overall when clinicians made an effort to double-check that parents were clear on the instructions given.

With that in mind, it may be helpful to briefly screen parents on their level of health literacy before proceeding with explanations. After giving instructions, it’s also beneficial for providers have parents repeat back what they heard – and ask them questions about the details – so they can quickly correct any misconceptions.

Arming parents with information they understand allows them to be more active and engaged in their children’s health and recovery.

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