Virtual home hospital for premature newborns aims at making parents feel more secure

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Prolonged hospitalization for premature and sick newborn children can be stressful for the entire family. Vestfold Hospital Trust therefore started remote follow-up so that families can be discharged from the hospital and move back into their own homes earlier. CheckWare has become a central part of the solution, making parents feel secure about handling the situation from the comfort of their own home, without the traditional physical hospital support.

Virtual home hospital for children is a possibility for premature and sick newborns to be discharged earlier from the Neonatal Intensive Care Unit at the hospital. The parents observe the child at home and communicate with the hospital through new digital technology for remote follow-up.

The innovation project started at Vestfold Hospital Trust two years ago. The project was a result of receiving innovation funds from the South-Eastern Regional Health Authority to come up with new solutions for home hospitals. The digital solutions are being piloted, and gradually introduced combined with consultation through video and telephone.

Vestfold Hospital Trust

Vestfold Hospital Trust is located in Vestfold and Telemark County in Norway, located on the South-Eastern coast of Norway.

The hospital trust is a part of the South-Eastern Regional Health Authority. The hospital operates in Tønsberg, Larvik and Stavern in Norway.

In 2021, the hospital had 94.500 patients, in which 1918 were related to births.

5.300 employees.

siv.no

The main purpose is to offer a secure and proper follow-up of premature newborn babies and their families who wish to continue the program from the comfort of their own homes. The clinicians at the Vestfold Hospital Trust evaluate each family’s needs before departure. The parents receive necessary training in use of medication, how to contribute to development of the child's skills, use of technical equipment and digital communication tools.

- Nobody must go home after a specific number of days at the Neonatal Intensive Care Unit. All children who return to their homes must be at least 34 weeks old and be approved by a pediatrician. These are small children who may not weigh more than two kilograms. It is only natural for the parents to ask themselves if they are comfortable going through with this. We provide them with guidance and training at the hospital in their own family rooms where they are allowed to care for the baby alone for at least 48 hours to master the care of their baby before leaving the hospital. Parents are saying that they would not have dared to return to their homes without the close follow-up that they receive from the hospital, says Heidi Wataker.

She is a pediatric nurse, has a master's degree in Health Promoting sciences. and has been the project manager for Virtual Home Hospital for Children for three years.

We provide them with guidance and training at the hospital in their own family rooms where they are allowed to care for the baby alone for at least 48 hours to master the care of their baby before leaving the hospital. Parents are saying that they would not have dared to return to their homes without the close follow-up that they receive from the hospital, says Heidi Wataker.

Heidi Wataker

Project manager for Virtual Home Hospital for children and pediatric nurse, Vestfold Hospital Trust

Daily follow-up

When leaving the hospital, parents may experience the situation as insecure: The guidance they are used to receiving from the hospital staff disappears. And for some families, frequent outpatient check-ups would also be stressful.

However, when returning to their homes in the Virtual Home Hospital project, the parents can use digital tools to maintain control, like measuring the child’s vital parameters. They observe, in example, breathing frequency, temperature, weight changes, the frequency of breastfeeding and the child's general behavior. They report these parameters directly in CheckWare, which then transfers the observations directly to the baby's medical record. Parents can use their own computer or borrow an iPad from the hospital.

At the beginning when returning home, the hospital wants the parents to report observations twice a week in CheckWare. The development is followed by a doctor and / or nurse. The nurse will give feedback daily, or by other agreed frequency, via secure messages. During the entire stay, the family can call the Neonatal Intensive Care Unit regardless of the time of day if they have questions.

The digital reporting solution in CheckWare contains, among other things, important information for the parents if the child changes its behavior. There is a separate page for recording measured observations. There is also a separate page where clinicians can have secure message dialogues with parents.

The development is followed-up by a doctor or a nurse. The nurse will provide feedback by agreement, via edited treatment plan and video call. Contact with parents helps the nurses to easily provide feedback and guidance in the home situation. During their entire stay, the family can call neonatal intensive care regardless of the time of day if they have any questions. In addition, the Digital Reporting Solution in CheckWare contains important medical information as well as technical equipment user guidance.

Mastering digital tools

- Parents receive good information before leaving the hospital, and we experience that the digital solutions are easy to use when the family has returned home and that the parents follow up well. Often, these are young people who do not consider the technical part of it a problem, so it is not a surprise that a digital version works well, says Wataker.

- There will always be challenges related to the initial phase of a new digital solution. Specific requirements change and testing often takes longer than expected. We want to work towards the optimal solution, and we have had a very good dialogue with CheckWare, which has worked actively to meet our requirements through the entire project.

The special thing about this solution is the integration with the medical records. The observations that the families make at home according to an agreed treatment plan must be entered into the child's medical record. To solve this, one of the parents are set up with a relation to the child's medical record. The observations are then received directly into the child’s medical records. The parents use a secure login, which is a requirement for security in relation to the storage of data.

- It's fun to have come this far, and 100% of the parents answering the user interface survey say that this is easy to use.

It's fun to have come this far, and 100% of the parents answering the user interface survey say that this is easy to use.

Heidi Wataker

Project manager for Virtual Home Hospital for children and pediatric nurse, Vestfold Hospital Trust

100% satisfaction

The project manager for Virtual Home Hospital emphasizes that the benefits of this health service are many. The families are offered an earlier return to their homes. It can contribute to better logistics by having the family gathered at home, instead of parents having to spend a lot of time at the hospital, often while maintaining family life at home with several children.

A hospital is often quite hectic, especially in an intensive care unit with frequent alarms and many people in and out, and this can be a disturbing environment for the child. In addition, there is a certain risk of infection.

Vestfold Hospital Trust's results

130 families have participated to this day.

100% satisfaction among participating families.

85% response rate on surveys.

By using the digital solution, the family avoids frequent trips for control at the hospital, journeys that can be very stressful and time-consuming for both the child and the parents, and instead get control and experience mastery at home. This can help promote self-mastery and make parents experts on their newborn children, instead of the powerlessness one can often be left with without receiving guidance. Providing parents with the correct guidance that create security is the hospital’s main goal.

- This is a service for a vulnerable group, where it is crucial that the transition from hospital to home works properly. Parents go from being less than two seconds away from the closest nurse, to overseeing the care the baby receives by themselves. We experience that the digital solution helps the parents taking good care of their premature children. We have seen very good results and experienced up to 100% satisfaction score from parents regarding the overall follow-up. I believe that this is a new future, where we can support more families with this solution than the traditional in-home medical visits. In addition, there will be fewer children admitted to the hospitals, which will free up resources for the children who are most in need of medical assistance, says Wataker.

When using Virtual Home Hospital, the parents are not least responsible for the child's nutrition and weight gain. Nutrition can be given in several different ways, either by breastfeeding, through a feeding tube or bottle. Some children are discharged from the hospital with a feeding tube, and in these situations, the hospital will want to receive continuous information about what the child receives from nutrition, breastfeeding frequency, bottle or tube meals. If it is relevant to measure heart rate and oxygen saturation at home, the family will bring home a pulse oximeter.

We experience that the digital solution helps the parents taking good care of their premature children.

We have seen very good results and experienced up to 100% satisfaction score from parents regarding the overall follow-up. I believe that this is a new future, where we can support more families with this solution than the traditional in-home medical visits. In addition, there will be fewer children admitted to the hospitals, which will free up resources for the children who are most in need of medical assistance.

Heidi Wataker

Project manager for Virtual Home Hospital for children and pediatric nurse, Vestfold Hospital Trust

A calm environment is important for premature and sick newborns

The Neonatal Intensive Care Unit is a department with many people and alarms from equipment. The pediatric nurse emphasizes how much a calm environment at home means for the normal development of the babies:

- Having a calm environment is important for the cognitive development of premature babies. In the last phase of the hospital stay, the child is in a growing phase, stable, but unable to eat everything by themselves. The child’s mother brings home a breastfeeding scale to control the amount of milk the baby drinks from the breast. Several of the participants have pointed out that the control they get from using a breastfeeding scale and the guidance has allowed them to continue breastfeeding the baby, Wataker says.

She adds:

- Through growth reporting and communication through the video solution, we have the opportunity to follow up on the baby’s nutrition in a proper way.

In addition, there is usually no difference in public financial support, even if the family is discharged from the hospital, if the need arises. It is the doctor at the hospital who assesses this, and it is the extent of the child's need for care and supervision that determines whether it is relevant for parents to receive a care allowance, including the length of assistance.

And after? The hospital wants a discharge interview, where the families hand in borrowed equipment, and the mother is asked about participating in a survey.

The survey consists of 25 questions measuring parents' satisfaction and experience with the virtual home hospital. The hospital has experienced a response rate of as much as 85% to the survey, which is only given to parents who have completed the entire program.

- So far, 100% of the respondents have said that they are satisfied with the comprehensive follow-up given through the virtual home hospital, says Heidi Wataker.

In addition, families are asked to consent to the use of the information from home hospitals for quality development, in order to evaluate and further develop the treatment service. All data remains anonymous.

The average length of stay is 15 days, and there is a readmission percentage of 7 percent, which in most cases is due to infections or other factors that require medical supervision. Wataker therefore feels that they have come a long way towards what is the goal: Confident parents who can go home early and start a normal family life with premature babies.

130 families have participated so far

To date, 130 families have possibility of being in a virtual home hospital. Several other hospitals have shown interest for the solution, and two other neonatal intensive care units have started using the solution.

"This is a gratifying development! We think that this group, which has experienced a long hospital stay, will greatly benefit from digital follow-up to promote security after returning home, says Heidi Wataker.

Wataker travels a lot to present the innovative solution to various stakeholders. In phase two of the project, the neonatal intensive care units in Drammen and in Ålesund in Norway will use the solution. Telemark is also very interested. The solution is also up for consideration by the Norwegian Ministry of Health and Care Services.

Wataker's wish is for children of all ages to be offered digital distance follow-up to ensure quality and safety for the child and the family in the future.

Vestfold Hospital Trust's use of CheckWare within Virtual Home Hospital

Respondent tools:

Measures
Plans
Assessment library
Self developed measures
Secure messages

Clinician tools:

Clinical reports
Clinician insight
Patient insight
Flag handling
Treatment roles
Raw data exports

System management tools:

System settings
Access control
System log
System reports
Respondent management
Clinician management
Authentication: Bank ID (Norway)

Integrations:

DIPS