Clinician Experiences Using a Collaborative Pediatric Virtual Health Model: Telehealth Rounding and Consultation for Kids(TRaCK)

ABSTRACT

Background: Pediatric admissions in Canada have demonstrated increasing complexity, acuity and subspeciality usage. However, subspecialists are concentrated in urban tertiary centres, forcing rural pediatric patients to travel long distances. Moreover, tertiary centres are in overcapacity while regional sites underutilize pediatric beds. Therefore, our team developed an innovative Telehealth-facilitated Rounding and Consultation Model for Kids (TRaC-K). TRaC-K is currently being piloted between a tertiary pediatric hospital (Alberta Children's Hospital), and a single regional hospital (Medicine Hat Regional Hospital) in the Canadian province of Alberta. To sustain, improve and scale-up the TRaC-K model, it is essential to understand the experiences of those using the model. Hence, the purpose of this study was to understand tertiary and regional site clinician experiences with providing inpatient clinical care using the TRaC-K model. Methods: This qualitative study was conducted after 3 months of piloting the TRaC-K model. Clinicians with the experience of using TRaC-K at tertiary and regional hospitals were recruited to participate in focus groups. These focus groups were conducted virtually to elicit their perspectives, experiences, and suggestions regarding the model. NVivo 12 was used to conduct inductive thematic analysis. The Donabedian model, a conceptual model commonly used for examining health services and evaluating quality of health care based on structure, process and outcomes was used as the framework to thematically analyze the qualitative data. Preliminary findings of this study are reported here. Results: In total, 15 clinicians participated in 6 focus groups across the two sites. Participants included physicians, nurses and allied health professionals. In terms of structure, clinicians identified that various members were involved in TRaC-K. The model aided in connecting multidisciplinary care teams from both hospitals as well as families, promoting inclusive participation. The telehealth monitor was easy to maneuver with good audio and visual quality. However, technology improvements included integrating TRaC-K with other platforms such as Zoom and providing captions. Regarding process, the onset of the COVID-19 pandemic and shift towards virtual health increased the applicability and uptake of the program. The clinicians suggested operational improvements such as off- hours availability, role clarifications, and more clearly defined goals. Despite suggested improvements, the program was easy to use and had beneficial outcomes such as collaborative decision making between the sites which increased confidence in inter-hospital transfer. Clinicians expressed that the program had the potential to be expanded into other patient populations and sites. Conclusion: These findings indicate that the users of the TRaC-K model felt that it was feasible and reported positive perceptions and experiences using TRaC-K. The findings from this study would help develop similar models to provide pediatric inpatient clinical care to rural children in other parts of the world.