Nicklaus Children’s Hospital is utilizing virtual care to help families with the transition from hospital to the home and to provide easier access for working parents.
Nicklaus Children’s Hospital has taken more than a few small steps in using telehealth to improve neonatal care.
The Florida hospital is using virtual care in a number of ways in treating neonatal patients. The hospital has developed a program, dubbed “Baby Steps”, to help families navigate the transition from the hospital to the home. Nicklaus is also using telehealth to check in with patients and families, and is offering support services to other hospitals virutally.
Danielle Altares Sarik, director of nursing research and evidenced-based practice at Nicklaus Children’s Health System, recently spoke with Chief Healthcare Executive® about telehealth and neonatal patients. She also outlined some of the barriers that must be addressed to ensure equitable access.
“I think that there is a lot of potential,” she says.
“With neonatal families, what we saw during the pandemic is they were actually so excited to have an option where they didn't have to come into a clinical setting, and be exposed to potential RSV, or COVID, or flu,” Sarik says.
For many parents, telehealth was appealing due to “the potential of just saving time and saving costs of not having to drive to an in-person appointment,” she adds.
“So I think we are growing our telehealth services," she says. "But I think there's still a lot of room for growth.”
Aiding patients and other hospitals
Sarik and other researchers outlined some of the success of Nicklaus’ telehealth program in an October 2023 article published by Critical Care Nursing Clinics of North America.
The telehealth appointments offer much more flexibility for some parents, who may have difficulty getting to an in-person appointment because they’re working, she says.
“When you think about our parent population, our caregivers, a lot of people work and they have a range of different types of jobs,” she says. “Some people can easily take a morning off, or take a day off to go in for an appointment. And for other people, that's really difficult.
“And so with telehealth, … they may have some more flexibilit. They can do it before work in the morning or in the evening, or on a lunch break. And so it really also kind of decreases some of those barriers to care we see, especially with our families who are working families and don't have flexibility.”
With Nicklaus’ Baby Steps program, nurses will meet with the family at the bedside before their baby is discharged. They’ll open up the application and essentially do a mock telehealth call, and walk them through the steps to connect virtually.
“We really think it's important to connect with the families in the hospital before they go home,” Sarik says.
Last spring, Nicklaus began using telehealth to provide assistance to other neonatal intensive care units.
“It's a nice way to be able to share those resources. And definitely, I think there's a need for it,” Sarik says.
She says that’s another area of potential expansion of telehealth to offer expertise to smaller hospitals.
Even for hospitals that are going to transfer patients to major medical centers, connecting virtually can offer guidance in stabilizing patients so they can be transferred safely.
“If they don't deal with these patients very often, if they aren't comfortable dealing with the level of acuity and they need to have a consult, I think that can be a huge benefit of telehealth,” Sarik says.
Sarik stresses the importance of making sure telehealth is accessible, and she says that poses some challenges. As health systems look to utilize telehealth effectively, they need to think about the barriers to access for some patients.
While about 95% of adults between the ages of 18 and 49 have smartphones, according to the Pew Research Center, some patients have very limited data plans, Sarik notes. For some of those patients, a regular phone call may be required over a video call.
Hospitals also need to consider other connectivity challenges, including issues with WiFi and broadband access in rural areas.
“That's going to be a continuing challenge for ensuring equity and accessing telehealth,” Sarik says.
It’s important to think about those impediments in the planning stages, “so that you don't get to the point of implementation, and then realize there's this whole segment of the population that aren't going to be able to access this awesome service,” Sarik says.
Health systems also need to consider language issues for patients who don’t speak English, or are less comfortable. At Nicklaus, a large number of patients speak Spanish, so they need telehealth appointments with clinicians who speak Spanish. If a Spanish-speaking provider isn’t available, the hospital will use an interpreter service or app translator.
“When you're using telehealth, you're so reliant on what the patient is saying and what your interpretation is, that if there's a language barrier, you can really miss out on a lot in the interaction,” Sarik says.
Sarik also cites the importance of training staff in telehealth.
With the “Baby Steps” program, nurses undergo a structured training for telehealth visits. Nurses go through training to assess the home environments of patients’ families during virtual visits, and to spot potential hazards. If a baby has to go home with oxygen, nurses will check to be sure there aren’t candles or other open flames.
They’ll also go over typical questions for parents. And nurses will get guidance on assessing physical and mental health so they can connect families to the appropriate resources.
“When done correctly, I think telehealth has an additional benefit of being able to see the patient and the family in their environment, and really meeting them where they are in a lot of different ways,” Sarik says. “But again, I think that the clinician needs to be really trained and has to understand how to appropriately assess those things and then act on them.”
Some parents are leery of using telehealth because they don’t want to show that their home is not quite tidy, so nurses also get guidance on weighing the typical mess that comes with a new baby against safety issues.
“We need to strike that right balance,” Sarik says. “We're here to give you advice and make sure that things are safe, but we're not here to judge you.”
“In our training with our nurses, we try to train them on these key things that they assess with each visit. And then they use their nursing expertise and their scope of practice to kind of expand on that in the visit and give the family and the patient what they need in the moment.”