背景:青少年自杀是一个紧迫的公共卫生问题,自杀危机后的护理过渡代表了一段高风险时期。护理和情感支持的连续性经常发生中断。“关怀联系人”在出院后验证消息有可能增强与患者的联系,并已被证明可以改善结果。最近,使用关怀联系短信(短信和彩信)已经注意到积极的结果,这有望让患者参与儿科环境,但是很少有研究描述这种方法的大规模实施。
目的:本研究旨在描述在质量改进框架内开发和实施自动化护理联系人的过程,使用一系列标准化的支持文本和图像,在中西部一家大型儿科医院接受高视力项目的青少年出院。我们描述了吸取的教训,包括成功的挑战和因素。
方法:我们分3个阶段实施关怀性接触干预。第一阶段需要开发旨在促进希望的支持性陈述和图像,包容性,和连接以创建2套8条文本消息和相应的图像。第二阶段包括在医院的精神科危机科和住院精神病科手动试行关怀性接触者,并评估在其他服务中实施的可行性,以及制定工作流程和解决法律问题。第3阶段包括实施自动化流程,以在4个参与医院服务中扩展,并将登记纳入医院的电子病历中。过程结果测量包括工作人员对接近和招募合格患者的依从性,以及参与者完成的可选后文调查的结果。
结果:提供了4062名符合护理接触条件的青少年患者的依从性数据。总的来说,88.65%(3601/4062)的符合条件的患者被接近,其中52.43%(1888/3601)参加。总的来说,94.92%(1792/1888)的注册参与者完成了该计划。符合条件的患者的比较,走近,已注册,并完成提交。符合条件的患者下降的主要原因包括无法使用手机(686/1705,40.23%)和护理人员更愿意在以后讨论干预措施(754/1705,44.22%)。对可选的后文调查做出回应的大多数患者报告说,这些文本使他们感到适度到非常有希望(219/264,83%),支持(232/264,87.9%),同行将得到这些文本的帮助(243/264,92%),并且他们希望在给定选项的情况下继续接收文本(227/264,86%)。
结论:这项研究描述了自动出院后护理接触文本的成功实施,以创新地使用图像并展示了质量改进方法如何导致更有效和高效的过程。本文还强调了技术的潜力,以加强对有风险的青年的照顾,并创造更多,包容性,可持续预防战略。
BACKGROUND: Youth suicide is a pressing public health concern, and transitions in care after a suicidal crisis represent a period of elevated risk. Disruptions in continuity of care and emotional support occur frequently. \"Caring contacts\" validating messages post discharge have the potential to enhance connections with patients and have been shown to improve outcomes. More recently, positive outcomes have been noted using caring contact text messages (SMS and MMS), which hold promise for engaging patients in a pediatric setting, but there are few studies describing the large-scale implementation of such an approach.
OBJECTIVE: This study aims to describe the process of developing and implementing automated caring contacts within a quality improvement framework, using a standardized series of supportive texts and images, for adolescents discharged from high-acuity programs at a large midwestern pediatric hospital. We describe lessons learned, including challenges and factors contributing to success.
METHODS: We implemented the caring contacts intervention in 3 phases. Phase 1 entailed developing supportive statements and images designed to promote hope, inclusivity, and connection in order to create 2 sets of 8 text messages and corresponding images. Phase 2 included piloting caring contacts manually in the hospital\'s Psychiatric Crisis Department and Inpatient Psychiatry Unit and assessing the feasibility of implementation in other services, as well as developing workflows and addressing legal considerations. Phase 3 consisted of implementing an automated process to scale within 4 participating hospital services and integrating enrollment into the hospital\'s electronic medical records. Process outcome measures included staff compliance with approaching and enrolling eligible patients and results from an optional posttext survey completed by participants.
RESULTS: Compliance data are presented for 4062 adolescent patients eligible for caring contacts. Overall, 88.65% (3601/4062) of eligible patients were approached, of whom 52.43% (1888/3601) were enrolled. In total, 94.92% (1792/1888) of enrolled participants completed the program. Comparisons of the patients eligible, approached, enrolled, and completed are presented. Primary reasons for eligible patients declining include not having access to a mobile phone (686/1705, 40.23%) and caregivers preferring to discuss the intervention at a later time (754/1705, 44.22%). The majority of patients responding to the optional posttext survey reported that the texts made them feel moderately to very hopeful (219/264, 83%), supported (232/264, 87.9%), that peers would be helped by these texts (243/264, 92%), and that they would like to keep receiving texts given the option (227/264, 86%).
CONCLUSIONS: This study describes the successful implementation of automated postdischarge caring contacts texts to scale with an innovative use of images and demonstrates how a quality improvement methodology resulted in a more effective and efficient process. This paper also highlights the potential for technology to enhance care for at-risk youth and create more accessible, inclusive, and sustainable prevention strategies.