From "boot camp" to discharge

Nurse with patientUnprepared or poorly trained caregivers for medically dependent children can result in poor patient outcomes, added caregiver stressors and increased financial strain on families and hospitals. Teaching caregivers to care for their complex medically dependent child can be a challenge. Infants and children are often discharged home with tracheostomies, ventilators, feeding tubes and other conditions that require specific learned skills. Patients are often limited in the amount of inpatient days allowed by insurance. If caregivers are not trained within allotted days, much of the inpatient stay is not reimbursed to the hospital or the caregivers are left with a substantial medical bill.

In January 2015, an evidence-based boot camp caregiver training program was initiated for all patients on Cook Children’s Transitional Care Unit (TCU). Boot camp training was defined as learning basic skills needed to care for their complex, medically dependent child in nine (three-hours each) structured sessions. This nurse-initiated boot camp addressed patient satisfaction and cost efficiency through clear training requirements with an agreed-upon schedule outlined during patient care conference, caregiver-signed training contract, updated room calendar with training, and rooming-in schedule.

The purpose of this study was to determine effectiveness and efficiency of a structured "boot camp" training-for-discharge program for 34 caregivers of medically dependent children on a transitional care unit. Cost-effectiveness and efficiency were measured by average length of stay, discharge teaching time, caregiver satisfaction and parental stress. Retrospective chart review was done to evaluate length of stay in TCU of a matched group of 34 medically dependent patients whose caregivers experienced the "usual care" discharge training program prior to January 2015.

The boot camp training program has significantly decreased the overall length of stay by 57%. This has created an estimated savings between $53,300-69,900 per patient.

TCU plans to introduce a family educator position to track future boot camp discharge education. Next steps include national dissemination of program results via publication and presentations.