300 - Safe and Understood: Nurse Key Worker to Improve Care Coordination for Children with Health Complexity

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 300
Publication Number: 300.204

Tessa Diaczun, BC Children's Hospital, Vancouver, BC, Canada; Amie N. Nowak, BC Children's Hospital, Vancouver, BC, Canada; Esther Lee, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada

Presenting Author(s)

Esther Lee, MD, FRCPC, FAAP (she/her/hers)

Pediatrician and Palliative Medicine Specialist
University of British Columbia Faculty of Medicine
Vancouver, British Columbia, Canada

Background: In British Columbia, Canada, the BC Children’s Hospital Complex Care program (CCP) serves children with health complexity (children with medical and psychosocial complexity-CHC). Up to 2021, the CCP had only part-time clinicians - physicians (MD) and a nurse practitioner (NP). As a pilot project, a full-time registered nurse (RN) joined us.

The role of the Nurse Key Worker (NKW) was to provide care coordination:
1. Arrange and support interprofessional team meetings,
2. Liaise with community supports,
3. Support service navigation across sectors (health, education, and social services).

Objective:

With the addition of a Nurse Key Worker, evaluate benefits perceived by the clinicians and families to the coordination of care of CHC.

Design/Methods:

Caseload: diverse sample of 30 families

Evaluation over 1 year

Demographics and encounters

Family Experience with Care Coordination (FECC) and Patient-Reported Outcome Measurement Information System (PROMIS) Self-Efficacy Surveys

Care Coordination Measurement Tool (CCMT)

Strength, Weaknesses, Opportunities, Threats (SWOT) analysis

Semi-structured interviews with families

Results:

FECC and PROMIS surveys

Completion rate: Baseline: 69%; 9-month: 54%

Families: very positive about the support received from CCP (baseline) and NKW (9-month)

CCMT

Within each encounter, NKW performed more activities and addressed more issues compared to the NP.

NKW encounters were < 30 minutes while NP encounters were < 10 minutes

50% of MD’s encounters could have been done by an RN

SWOT

Strength: “Families are now able to receive more continuity and support, hence reducing the strain on other staff and allowing them to focus on more medical management.”

Threats: NKW burnout; Lack of permanent funding

Semi-structured Interviews with families

“The [CCP] knows more about my child than anybody. We feel safe and understood when expressing our needs.”

“Since [the NKW] got involved, we haven’t had to go to the [emergency room]."

“With the NKW involvement, I spend less time trying to understand who can and will talk to me. I don’t worry that no one will call me back.”

“[The NKW] makes sure we understand what was said by [clinician] when we are not sure. She understands and really cares for our family and helps us stay calm in very difficult situations.”

Conclusion(s):

We submitted a business plan along with this pilot project info and was successful in securing permanent funding for two full time NKW positions.

We are working on applying for funding for a program evaluator so that the team members are not doing the ongoing evaluating work on top of their clinical roles.