146 - Implementation of a Post-Discharge Remote Patient Monitoring Program for Patients with Failure to Thrive

Poster Number: 146
Publication Number: 146.416

Courtney Sump, Cincinnati Children's Hospital Medical Center, Fort Thomas, KY, United States; Kylee Denker, Cincinnati Children's Hospital Medical Center, Lebanon, OH, United States; DaVona Chapman, Cincinnati Children's Hospital Medical Center, cincinnati, OH, United States; Christine White, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Sarah Riddle, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Patients hospitalized for failure to thrive (FTT) require frequent outpatient visits after discharge to monitor weight. Utilizing remote patient monitoring (RPM) to follow patient weights and feeding patterns from home has the potential to improve access to care while mitigating social challenges families face (e.g., transportation, childcare, time off work).

Objective: To implement an RPM program for patients hospitalized with FTT and increase enrollment of eligible patients from 0 to 95% by December 31, 2021.

Design/Methods: Our improvement team partnered with hospital-based safety net clinics to enroll patients into an RPM program who were admitted to Hospital Medicine at a large, academic children’s hospital with FTT who weighed less than 18 kg,. We provided a scale and smart phone application to families who submit weights and feeding questionnaires twice a week. RPM nurses received the data and followed a clinical algorithm directing next steps and interventions. Using the Model for Improvement, we created a process map and a key driver diagram (Figure 1), which included early identification of qualifying patients, reliable process ownership for enrollment, and real-time feedback on enrollment. Interventions included: identification of eligible patients with real-time mitigation to primary inpatient team, handouts to aid in enrollment and promote family engagement, and dissemination of program information to key stakeholders. The percentage of eligible patients enrolled was tracked on an annotated run chart to assess the effect of our interventions over time. Other outcomes include family satisfaction (based on 60-day survey) and number of in-person weight checks after discharge.

Results: Through our interventions, we increased the median percentage for eligible patients enrolled from 0 to 80% (Figure 2). Failure modes include: missed identification of eligibility, family declined, and inability to enroll non-English speaking patients. Family satisfaction was high (Figure 3). In-person weight checks ranged from 0 to 5, and 4 patients required 0 in-person weight checks due to demonstrating adequate weight gain via RPM.Conclusion(s): We successfully implemented and increased the percentage of patients enrolled in a novel RPM program for FTT following hospital discharge. There is opportunity to improve enrollment rates, especially in families who do not speak English. This program is associated with high family satisfaction and may cut back on in-person weight checks. Our next steps are to compare clinical outcomes, such as weight gain, before and after implementation of RPM.
Figure 1: Key Driver Diagram for enrollment into Remote Patient Monitoring program for failure to thrive
Figure 2: Run Chart for Percent of Eligible Failure to Thrive Patients Enrolled in Remote Patient MonitoringEnrollment rate increased from 0% to 80% with implementation of program and utilization of quality improvement methods.