Nursing care delivery 2022 | Children's Minnesota

Cutting-edge The Kid Experts™ At Home monitoring program expands with impressive outcomes

Children’s Minnesota’s innovative The Kid Experts™ At Home monitoring program allows infants in the neonatal units who meet certain criteria to be discharged from the hospital sooner, with expert care and monitoring continuing at home. Since the program was launched in 2021, infants who started in the NICU have spent 218 fewer days hospitalized because they were able to receive expert care and monitoring at home. It’s the only program of its kind in Minnesota. 

Historically, a hospitalized infant was discharged to home based on reaching a certain size, weight or gestational age; sufficient oral feeding; and any additional medical complications. Sufficient oral feeding is often the last competency to be reached, requiring clinical nurses to perform feedings, assess the infant’s status and educate families.  

Program development

In 2020, a team of clinicians at Children’s Minnesota launched a study to evaluate the feasibility of an early discharge program utilizing nasogastric (NG) tube feedings, home care, and daily virtual care visits with a neonatologist and the care team using an application on a smart device. The study, which ran from November 2020 to July 2021, enrolled 20 infants and was tremendously successful with no serious adverse events. Additionally, full oral feedings were achieved more quickly than inpatient infants.

Based on these encouraging results, Children’s Minnesota moved towards a full implementation of the program across the neonatal division, starting with the St. Paul NICU and Minneapolis Special Care Nursery (SCN) in February 2022 and the Mercy Hospital NICU in May 2022. There are plans to expand the program to the Infant Care Center (ICC) in May 2023.

The core team consisted of neonatologists, a nurse practitioner, a clinical nurse specialist, nursing leadership, home care and the NICU Follow-up Clinic. As the program expanded, additional team members from speech therapy, lactation and special diagnostics were added.  

Clinical nurses are key to the program’s success

The Kid Experts™ At Home monitoring program consists of several equally important parts to assure a successful transfer to the home environment: Patient identification, caregiver education, home care nursing, equipment support and technology support. Clinical nurses are crucial in helping identify patients who could be successful in the program because of their consistent presence and interactions with the infant and families.

Once a patient is identified and the family agrees to participate, the clinical nurse will educate the caregivers on using the NG tube, as well as how to administer feedings, record information into the app and perform CPR. Then from the home environment, the caregivers will meet virtually with a neonatologist on a daily basis until the infant reaches full feedings and is discharged from the program.

The program provides expert, specialized care for the most vulnerable patients. It helps more families enjoy special time together in those first few weeks, under their own roof while cutting-edge technology keeps their care team close by.

The Kid Experts™ At Home has forged new ground in how Children’s Minnesota provides expert, specialized care for our most vulnerable patients. The success and expansion of the program is a testament to how Children’s Minnesota is committed to pioneering new resources that always put our patients first.”

– Dr. Cristina Miller, medical director of the NICU Follow-up Clinic at Children’s Minnesota, and founder and director of The Kid Experts™ At Home monitoring program

Program participants

Samantha Becker, BSN, RN, Patient Care Manager, Minneapolis Special Care Nursery
Mark Bergeron, MD, Neonatologist, Neonatal Services
Maija Cardille, BSN, RN, Manager of Home Health, Home Health Care
Laurel Diede, MS, RN, Case Management and Care Traffic Control Center Supervisor, Case Management
Robyn Gizzi, APRN, CNP, NNP, Neonatal Nurse Practitioner, Neonatal Services
Cristina Miller, MD, Neonatologist, Neonatal Services
Corbin Moulder, BSN, RN, Patient Care Supervisor, St. Paul NICU
Kirsten Provart, BSN, RN, CBC, NTMNC, Patient Care Supervisor, Minneapolis Special Care Nursery
Jennifer Rivera, DNP, APRN, ACCNS-N, RNC-NIC, Clinical Nurse Specialist, Center for Professional Development and Practice
Christine Schmidt, Clinic Assistant, NICU Follow-Up Clinic

Nurse practitioner team from cardiovascular intensive care unit integrates technology to support complex discharges

Single ventricle physiology patients are one of the most critical patient populations seen on the cardiovascular intensive care unit (CVICU) at Children’s Minnesota. These fragile children have a rare birth defect in one lower chamber of the heart, making the chamber smaller, underdeveloped or missing a valve. Caring for these patients often requires multiple surgeries to reconfigure the heart and circulatory system. They are high-risk for developing complications and require close monitoring.

It is possible to discharge a patient with single ventricle physiology home after the first stage of repair is done, but the process is extremely complex for the health care providers and the patient’s family. Caregivers are expected to perform tasks like daily weights, oxygen saturation monitoring, preparing formula requiring complex mixtures and administering multiple medications. They also need to track data to identify trends and changes, which may indicate a complication or the need to be admitted back to the CVICU for their next stage of repair. Despite the challenges, research and experience has shown that sending these children home on a regimented program with regular follow-up leads to the best outcomes.  

When the home monitoring program was first established at Children’s Minnesota, parents would write on a paper log to track data. This system was sufficient, but far from perfect. Lost records, difficulty transcribing data, and frequent additional visits to the clinic and/or hospital when concerns couldn’t be addressed over the phone placed additional stress and anxiety on caregivers.

These challenges were the catalyst for a nurse practitioner team in the Children’s Minnesota CVICU to innovate a better discharge and monitoring process. Cardiology Nurse Practitioners, Jocelyn Berbee, APRN, CPNP; Amy Weiler, APRN, CPNP; and Andrea Lueck, APRN, CPNP, partnered with Brittany Dahlen, MSN, RN, NPD-BC, CPN, CPDP, a clinical education specialist with a simulation focus, developed a discharge simulation program for caregivers integrating technology on iPads. The technology, Locus, is a virtual care platform specifically designed for pediatric remote patient monitoring. The Children’s Minnesota team tailored the remote monitoring program for the caregivers of patients with single ventricle physiology.

Following the caregiver simulation program development, CVICU clinical nurses Jamie Heil, BSN, RN, CCRN, CBC; and Jessica Hannan, BSN, RN, gave opportunities for caregivers to practice the procedures they would need to provide for their children, as well as the data they would input into Locus, in a simulated home-like environment. The new system allows caregivers to take a photo or video of a concern and send it to the nurse practitioners for consultation versus bringing their child to the clinic.

The CVICU nurses love the comprehensive and reliable new system, and report caregivers feel considerably more confident and less anxious when taking their fragile child home. The nurses report receiving better patient data and being aware of issues earlier so patients are more stable upon readmission and can receive the best care.

Project members

Jocelyn Berbee, APRN, CPNP, Nurse Practitioner, Cardiology
Brittany Dahlen, MSN, RN, NPD-BC, CPN, Center for Professional Development and Practice
Jessica Hannan, BSN, RN, Clinical Nurse, Cardiovascular ICU
Jamie Heil, BSN, RN, CCRN, CBC, Clinical Nurse, Cardiovascular ICU
Andrea Lueck, APRN, CPNP, Nurse Practitioner, Cardiology
Heidi Shafland, MSN, APRN, ACCNS-P, CCRN-K, Clinical Nurse Specialist, Cardiovascular ICU
Amy Weiler, APRN, CPNP, Nurse Practitioner, Cardiology

Nurse team creates chronic ventilation roadmap for families

Annually, hundreds of children in the U.S. develop chronic respiratory failure (CRF) and become dependent on long-term ventilation, either invasive via a tracheostomy or noninvasive. Most of these children have other severe medical conditions that make them medically fragile with many functional limitations. Long-term or chronic ventilation requires constant, complex care at home with collaborative support between the patient’s health care team and their family.

The decision to chronically ventilate a patient is difficult, as is the process to do so. It involves clinicians from multiple disciplines, patient family education, specialized equipment, testing and waiting. Understandably, caregivers are often overwhelmed with the decision to chronically ventilate their child, and the process to set up their child at home comfortably and safely.  

Initial chronic ventilation road map

A team of Children’s Minnesota nurses identified an opportunity to make the process more streamlined for everyone involved.

In 2018, Jamie Heil, BSN, RN, CCRN, CBC, clinical nurse for the cardiovascular intensive care unit (CVICU), began an evidence-based project to identify a standardized approach across the organization. Jamie did a thorough literature review and researched other organizations’ processes for implementing and managing patients needing chronic ventilation.

In 2022, the process map was finalized, and work shifted towards creating a patient family chronic ventilation roadmap to align the processes followed by Children’s Minnesota. Austin Rondou, MSN, RN, CNL, CCRN, clinical nurse for the Minneapolis PICU; and Janelle Koscinski, BA, CHES, clinical education specialist, Center for Professional Development and Practice (CPDP), spearheaded roadmap drafting in collaboration with Families as Partners program participants to gather input based on their experiences.

For families: Chronic ventilation road map

Brittany Dahlen, MSN, RN, NPD-BC, CPN, clinical education specialist, CPDP; and Heidi Shafland, MSN, APRN, ACCNS-P, CCRN-K, clinical nurse specialist, CVICU, supported the project by drafting the roadmap for health care providers and ensuring appropriate entities approved.

Nurses drove the project from initial identification to implementation. They worked across teams and units to standardize, create, and share available tools for bedside staff and patient families. The chronic ventilation roadmap will now be the one process tool used by clinical nurses, multi-disciplinary groups and patient families across Children’s Minnesota.

Project members

Brittany Dahlen, MSN, RN, NPD-BC, CPN, Clinical Education Specialist, Center for Professional Development and Practice
Jamie Heil, BSN, RN, CCRN, CBC, Clinical Nurse, Cardiovascular ICU
Janelle Koscinski, BA, CHES, Allied Health Education Specialist, Center for Professional Development and Practice
Austin P. Rondou, MSN, RN, CNL, CCRN, Clinical Nurse, Minneapolis PICU
Heidi Shafland, MSN, APRN, ACCNS-P, CCRN-K, Clinical Nurse Specialist, Cardiovascular ICU