Prolonged hospitalizations for premature and sick newborns can be stressful for the entire family. Sykehuset i Vestfold has therefore started digital home follow-up so that families can go home earlier while still feeling secure, without the traditional physical hospital support. Digital solutions provided by CheckWare form a central part of the solution.
The virtual home hospital for children is an offer of early discharge from the Neonatal Intensive Care Unit for premature and sick newborns. Parents observe the child at home and communicate with the hospital via new digital technology for remote follow-up.
An innovation project launched at Sykehuset i Vestfold two years ago as a result of Innovasjon Helse Sør-Øst funding to rethink home hospital care. The digital solutions are being tested and gradually introduced alongside video and phone consultations.
The main goal is to offer safe and good follow-up for premature babies and families using the service. Healthcare personnel at Sykehuset i Vestfold conduct a needs assessment for the entire family before discharge.
Parents receive necessary training in medication use, child development skills, technical equipment, and digital communication tools.
- No one is required to go home after a set number of days from the neonatal intensive care unit; the offer is voluntary. Children who go home must be at least 34 weeks old and approved by a pediatrician. These are small children who may weigh no more than two kilos. It is entirely natural for parents to question whether they actually dare. We provide guidance and training in the last period before discharge, in dedicated family rooms where they get to have the baby alone for at least two days to manage care around the clock. Parents say they wouldn’t have dared to go home earlier without close follow-up from the hospital, says project manager Heidi Wataker.
She is a pediatric nurse, holds a master’s degree in health promotion, and has for three years been the project manager for the Virtual Home Hospital for Children.
We provide guidance and training in the last period before discharge, in dedicated family rooms where they get to have the baby alone for at least two days to manage care around the clock. Parents say they wouldn’t have dared to go home earlier without close follow-up from the hospital.
Followed up daily
Upon discharge from the hospital, parents may in some cases feel uncertain: The guidance they were used to receiving firsthand at the hospital disappears. And for some families, frequent outpatient check-ups can also be burdensome.
After discharge in the Virtual Home Hospital project, however, parents can use digital tools to maintain control themselves, including measuring vital parameters of the child. They observe the child according to the treatment plan, monitoring breathing, temperature, weight changes, breastfeeding frequency, and general behavior, for example. These observations are reported in CheckWare, which then transfers them directly to the child's journal in DIPS. Parents can use their own computer or borrow an iPad.
At the start of the home stay, the hospital wishes for parents to report observations twice a week in CheckWare. Progress is followed up by a physician and/or nurse. The nurse provides feedback daily, or as agreed, via secure messages. The family can call the neonatal intensive care unit at any time of day throughout the stay if they have questions.
The digital reporting solution in CheckWare includes important information for parents if the child's behavior changes. There is a dedicated page for registering measured observations. There is also a separate page where clinicians can engage in secure message dialogues with the parents.
Parents enter the measured parameters twice a week, which are followed up through video calls with a nurse. Progress is monitored by a physician and nurse. The nurse provides feedback as agreed, through an edited treatment plan and video calls. Contact with parents enables nurses to easily provide feedback and guidance for the home situation. Families can call the neonatal intensive care unit at any time of day during the entire stay if they have questions.
The digital reporting solution in CheckWare also contains important medical information and user guides for technical equipment.
Full mastery of digital tools
- There is good information flow prior to discharge, and we find that the digital solutions are easy to use once the family is home and that parents follow up well. Often, these are young people who do not see the technical aspects as a problem, so it is not surprising to me that the digital tools work well, says Wataker.
Wataker continues:
- There will always be some challenges in the initial phase of a new digital solution. Specific requirements change along the way, and testing often takes longer. We strive for the optimal and have throughout had excellent dialogue with CheckWare, who have actively worked to meet our requirements.
- What is special about this service is the integration with the medical journal. Observations families make at home according to a treatment plan go directly into the child's journal. Work has been done on role linking. Mother or father must be connected with the child’s journal so that observations are stored with the child. Parents use BankID, which is required for data security.
- It’s exciting to have come this far, and 100% of parents in the user interface survey respond that it is easy to use.
It’s exciting to have come this far, and 100% of parents in the user interface survey respond that it is easy to use.
100% are very satisfied
The project manager for the Virtual Home Hospital emphasizes that the benefits of such a scheme are many. One advantage is that families have the option of earlier discharge.
This can improve logistics by keeping the family together at home, instead of parents having to spend much time at the hospital while daily life at home, often with multiple children, continues. Hospitals can often be quite hectic, especially in an intensive care unit with frequent alarms and many people coming and going, which can be noisy for the child. There is also a certain risk of infection.
With the digital solution, families avoid frequent trips for hospital check-ups, which can be very demanding and time-consuming for both child and parents, and instead gain control and mastery at home. This can promote self-management and turn parents into experts on their newborns, instead of the helplessness they often feel. Guidance that creates security is a main goal from the hospital’s side.
- This offer is aimed at a vulnerable group where it’s important that the transition from hospital to home works properly. You go from being two seconds away from the nearest nurse to being home and managing the new situation yourself. We find that the digital solution makes parents feel more secure about their prematurely born children. We have seen such good results and have experienced up to 100% very satisfied parents regarding overall follow-up. I believe this is a future where more families can be reached than is traditionally possible with home visits. In addition, there will be fewer children admitted, which can free up resources and hands for the sickest children, says Wataker.
Using the Virtual Home Hospital, parents also take on responsibility for the child’s nutrition and weight gain. Nutrition can be provided in various ways, whether breastfeeding, tube feeding, or bottle feeding. Some children go home with a feeding tube, and the hospital wants to continuously know what nutrition the child receives—whether bottle or tube meals—and breastfeeding frequency. If measuring pulse and oxygen saturation at home is relevant, the family will receive a pulse oximeter.
We find that the digital solution makes parents feel more secure about their prematurely born child. We have seen such good results and experienced up to 100% very satisfied parents regarding the overall follow-up. I believe this is a future where more families can be reached than is traditionally possible with home visits. In addition, there will be fewer children admitted, which can free up resources and hands for the sickest children.