When a child is sent home from the hospital after a serious injury or illness, the ongoing medical care for that child can be overwhelming for parents. Home Care services provide a smooth transition to home and assists parents in accessing the required ongoing care ordered by a physician.
Andrea Toomay, Children’s Mercy Home Care, joins us to discuss the pediatric home care services and the value they provide to families.
Selected Podcast
Pediatric Home Care: Sending Kids Home Safely and Reducing Readmissions
Featured Speaker:
Andrea Toomay
Andrea Toomay, RN, BSN, BSW, CPN is Interim Director of Children’s Mercy Home Care. Andrea has worked with the pediatric population for her entire nursing career. At Children’s Mercy, she has worked in the Intensive Care Nursery and Home Care. Andrea has a passion for taking care of children in their own environment, where they heal the best! Transcription:
Pediatric Home Care: Sending Kids Home Safely and Reducing Readmissions
Dr. Michael Smith (Host): Our topic today is “Pediatric Home Care: Sending Kids Home Safely and Reducing Readmissions”. My guest is Andrea Toomay. She is a registered nurse and the Interim Director of Children's Mercy Home Care. Andrea, welcome to the show.
Andrea Toomay (Guest): Thank you.
Dr. Smith: Obviously, you spend a lot of time working in the home care services and so I just want to hear from your own experiences. Why you think home care services are so important?
Andrea: Home care services are so important to the children and our community because children really feel the best at home, in their own environment. They're there with the people that love them the most, and so we have found that bringing the children back to their home where they're comfortable, where they're able to heal the best, makes the best outcome for them.
Dr. Smith: Yes, I think it's true and I think most physicians and nurses would agree that, whether children or adults, the faster we get people out of the hospital the better, right?
Andrea: Absolutely.
Dr. Smith: But then, of course, we've got to make sure that we're doing the appropriate thing for them in the home setting and that's why I think the work that you do is so important. So, when there's an in-patient, when there's a child admitted in the hospital, at what point does your team start to engage with the family and the patient to prepare them to go home?
Andrea: Sure. Typically, it varies on when we are notified that the patient might need Home Health Services. We do have a hospital liaison that is based in our main campus hospital and she is there to answer any question on health service and she really is our true first phase of home care to those patients and their families. What happens is that the care managers at the hospital typically contact her or they'll contact her at intake desk at the home care office, and that starts the referral process. So, we know that we are going to be asked to be involved with this patient and their family. Our hospital liaison will then to go into their room and introduce herself and tell the family about the home care services that we’ll provide. Then, we start checking insurance authorization and things like that to make sure that this will be covered for the family. It truly starts as they are in the hospital, we start teaching, and we start prepping for what we will do for them at home.
Dr. Smith: So, besides that liaison, how many other people and what other professionals are part of the home care team?
Andrea: Like I said, we do have an intake desk that is fully staffed with registered nurses. So, whenever referral comes into the intake desk we are able to speak clinically to those folks about what their needs are for that specific patient. We also have therapy staff, which is the OTP chief, speech therapist and then a social worker. We have several registered nurses on staff and most of them have pediatric certifications as well. We do have a line of DME, which is durable medical equipment. Those are things such as the formulas, NG tubes, feeding tubes. We also have pharmacies services. So, any patient that would need to go home on IV, antibiotics, TPN liquids--those type of things, we are able to service those needs as well.
Dr. Smith: Let's talk a little bit more about the services you provide more specifically. You touched on a few things there. What exactly are the services that your home care team is going to provide?
Andrea: The skilled nursing in the home which would be the direct care to the patient. We really try to teach the family how to do self-care. So, the nurses in the home are doing a lot of education. For example, how to put down a NG tube, change a G tube, change an infusion pump, and bag and medication, and things like that. A lot of times the patient will need a full service care. We would add a physical therapy. We would add occupational therapy, speech pathology. We also have a social worker, like I said, and the social worker helps with the family and our nursing staff, and our therapy staff as a whole. She's looking at the entire picture of the home environment and helping to get community resources to these families who are having a hard time bringing their child home. It's not something that's normally planned. She really does a good job of helping them transition to the new normal.
Dr. Smith: How many children are we talking about here that require home care services?
Andrea: It is a wide variety. We have hundreds of patients on staff that require the durable medical equipment and about the same for the house services as well at any given time. It's a wide variety and we were just talking about this service, we go out fifty five miles from our main hospital location. We service Missouri and Kansas, and we catch a wide variety of kids within that area.
Dr. Smith: I guess with the recognition, as we said at the beginning of the discussion, Andrea, that obviously, we recognize now that the faster we get people out of the hospital the better. So, obviously, home care services is something that's going to need to expand. How do you see the role of your team working in the future? Are there plans to expand, to add staff? What is Children's Mercy planning on doing to support home care services?
Andrea: We are planning to hire several more nurses and several more therapy staff as well. We will double our PT and OT staff as well as our nursing staff. We do have plans to hire, they're called “admission nurses”. They will cover some of those weekend admission that are heavily being requested that we do that as well. So, yes, we are going to be expanding and we have the hospital support to do that.
Dr. Smith: On the flip side of all this, yes, we want children to leave the hospital as soon as they can, but on the flip side of that we don't want them to come back. So, that's really one of the goals of your department is to reducing the readmissions. How is that going?
Andrea: You're exactly right, and that's why we focus on self-care. That really means that the family is learning how to care for their child at home. Our nurses and our therapy staff go in and they're normally there for about an hour or an hour and a half at any given day of the week, whenever their visit is. So, really, the family is left in charge all the other hours of the day. So, our focus and one of our goals is to make sure the family really feels comfortable taking care of that kiddo, and that's what keep them out of the hospital. Changing a wound dressing or doing the infusion and making sure that is the cleanest way to do it so they don't get infected. Those are the very good skills of our nursing staff and they explain these are the reasons why you do this--to keep the kids out of the hospital, so we are seeing a big difference.
Dr. Smith: Well, that's great. I'm really excited for the work that you're doing, and I'm excited to see the home care services expand. Obviously, it's so needed and it's critical to the overall health of our kids in our community. Andrea, thank you for the work that you're doing. Thanks for coming on the show today. You're listening to Transformational Pediatrics with Children's Mercy Kansas City. For more information, you can go to www.childrensmercy.org. That's www.childrensmercy.org. I'm Dr. Mike Smith. Thanks for listening.
Pediatric Home Care: Sending Kids Home Safely and Reducing Readmissions
Dr. Michael Smith (Host): Our topic today is “Pediatric Home Care: Sending Kids Home Safely and Reducing Readmissions”. My guest is Andrea Toomay. She is a registered nurse and the Interim Director of Children's Mercy Home Care. Andrea, welcome to the show.
Andrea Toomay (Guest): Thank you.
Dr. Smith: Obviously, you spend a lot of time working in the home care services and so I just want to hear from your own experiences. Why you think home care services are so important?
Andrea: Home care services are so important to the children and our community because children really feel the best at home, in their own environment. They're there with the people that love them the most, and so we have found that bringing the children back to their home where they're comfortable, where they're able to heal the best, makes the best outcome for them.
Dr. Smith: Yes, I think it's true and I think most physicians and nurses would agree that, whether children or adults, the faster we get people out of the hospital the better, right?
Andrea: Absolutely.
Dr. Smith: But then, of course, we've got to make sure that we're doing the appropriate thing for them in the home setting and that's why I think the work that you do is so important. So, when there's an in-patient, when there's a child admitted in the hospital, at what point does your team start to engage with the family and the patient to prepare them to go home?
Andrea: Sure. Typically, it varies on when we are notified that the patient might need Home Health Services. We do have a hospital liaison that is based in our main campus hospital and she is there to answer any question on health service and she really is our true first phase of home care to those patients and their families. What happens is that the care managers at the hospital typically contact her or they'll contact her at intake desk at the home care office, and that starts the referral process. So, we know that we are going to be asked to be involved with this patient and their family. Our hospital liaison will then to go into their room and introduce herself and tell the family about the home care services that we’ll provide. Then, we start checking insurance authorization and things like that to make sure that this will be covered for the family. It truly starts as they are in the hospital, we start teaching, and we start prepping for what we will do for them at home.
Dr. Smith: So, besides that liaison, how many other people and what other professionals are part of the home care team?
Andrea: Like I said, we do have an intake desk that is fully staffed with registered nurses. So, whenever referral comes into the intake desk we are able to speak clinically to those folks about what their needs are for that specific patient. We also have therapy staff, which is the OTP chief, speech therapist and then a social worker. We have several registered nurses on staff and most of them have pediatric certifications as well. We do have a line of DME, which is durable medical equipment. Those are things such as the formulas, NG tubes, feeding tubes. We also have pharmacies services. So, any patient that would need to go home on IV, antibiotics, TPN liquids--those type of things, we are able to service those needs as well.
Dr. Smith: Let's talk a little bit more about the services you provide more specifically. You touched on a few things there. What exactly are the services that your home care team is going to provide?
Andrea: The skilled nursing in the home which would be the direct care to the patient. We really try to teach the family how to do self-care. So, the nurses in the home are doing a lot of education. For example, how to put down a NG tube, change a G tube, change an infusion pump, and bag and medication, and things like that. A lot of times the patient will need a full service care. We would add a physical therapy. We would add occupational therapy, speech pathology. We also have a social worker, like I said, and the social worker helps with the family and our nursing staff, and our therapy staff as a whole. She's looking at the entire picture of the home environment and helping to get community resources to these families who are having a hard time bringing their child home. It's not something that's normally planned. She really does a good job of helping them transition to the new normal.
Dr. Smith: How many children are we talking about here that require home care services?
Andrea: It is a wide variety. We have hundreds of patients on staff that require the durable medical equipment and about the same for the house services as well at any given time. It's a wide variety and we were just talking about this service, we go out fifty five miles from our main hospital location. We service Missouri and Kansas, and we catch a wide variety of kids within that area.
Dr. Smith: I guess with the recognition, as we said at the beginning of the discussion, Andrea, that obviously, we recognize now that the faster we get people out of the hospital the better. So, obviously, home care services is something that's going to need to expand. How do you see the role of your team working in the future? Are there plans to expand, to add staff? What is Children's Mercy planning on doing to support home care services?
Andrea: We are planning to hire several more nurses and several more therapy staff as well. We will double our PT and OT staff as well as our nursing staff. We do have plans to hire, they're called “admission nurses”. They will cover some of those weekend admission that are heavily being requested that we do that as well. So, yes, we are going to be expanding and we have the hospital support to do that.
Dr. Smith: On the flip side of all this, yes, we want children to leave the hospital as soon as they can, but on the flip side of that we don't want them to come back. So, that's really one of the goals of your department is to reducing the readmissions. How is that going?
Andrea: You're exactly right, and that's why we focus on self-care. That really means that the family is learning how to care for their child at home. Our nurses and our therapy staff go in and they're normally there for about an hour or an hour and a half at any given day of the week, whenever their visit is. So, really, the family is left in charge all the other hours of the day. So, our focus and one of our goals is to make sure the family really feels comfortable taking care of that kiddo, and that's what keep them out of the hospital. Changing a wound dressing or doing the infusion and making sure that is the cleanest way to do it so they don't get infected. Those are the very good skills of our nursing staff and they explain these are the reasons why you do this--to keep the kids out of the hospital, so we are seeing a big difference.
Dr. Smith: Well, that's great. I'm really excited for the work that you're doing, and I'm excited to see the home care services expand. Obviously, it's so needed and it's critical to the overall health of our kids in our community. Andrea, thank you for the work that you're doing. Thanks for coming on the show today. You're listening to Transformational Pediatrics with Children's Mercy Kansas City. For more information, you can go to www.childrensmercy.org. That's www.childrensmercy.org. I'm Dr. Mike Smith. Thanks for listening.