Case Study

Peer Mentoring for Complex Patients

Following through to provide care beyond the hospital walls can take many different forms and serve families with infants in a wide range of circumstances. The team at Golisano Children’s Hospital at the University of Rochester have been awarded a Take Action to Follow Through grant to develop a peer mentorship program for families of infants discharged with gastrostromy tube (GT) placements and partner with families to reduce emergency room admission after discharge.

While GT placements are fairly common and considered low morbidity and short hospital stay, an estimated 15 percent of patients have an ER visit within 90 days of placement. Furthermore, there is inequity in the patient population presenting to the ER, which is largely represented by patients with higher health care burdens due to social determinants of health.

The QI team at Golisano Children’s believes many emergency visits could be avoided by providing more support to high-risk families. Their effort could help reduce the burden on a congested and costly health care system while reducing the emotional and financial burden for caregivers and families.

Peer support in the NICU has been shown to increase confidence and well-being and provide other benefits for families caring for infants, and it is a core element of the improvement project. They aim to recruit 10-15 parents of children with gastrostromy tubes to match with 40 patients who will be discharged with a GT. They will meet at least once before discharge to cover GT-specific information and other areas of concern and will meet again at least twice post-discharge.

Along with peer support mentorship, the team will also make improvements to emergency GT kits informed by parents and Child Life Specialists. These changes, which include color-coding and adding personalized calming support materials, are intended to help parents manage emergency dislodgements without a visit to the ER.

Golisano Children’s Hospital has a dedicated G-tube QI working group, which includes a parental advisor, that will inform and implement this project. The hospital also works with a Pediatric Perioperative Surgical Home (PPSH) model, which has shown to improve outcomes by assessing family challenges and barriers prior to elective surgeries, including GT placements.

This grant was possible because of matching funds from the UR Medicine Quality Institute. The grant application was written by Mariah Erlick a fourth year student whose time is funded by an NIH grant in the University of Rochester Clinical Translation Science Institute (CTSI). The competitive Take Action to Follow Through grant program is open for members participating in VON QI collaboratives (NICQ/iNICQ) and supports implementation of VON Potentially Better Practices for Follow Through.

The team will measure the impact of these changes through surveys, number of emergency visits, and percentage of emergency visits preceded by a call to a provider. Following QI methodology, the team plans for iterative changes to the program based on collected data, participant feedback, and the needs of parents. The peer support mentorship model could also be extended to other high-risk groups in the future. They will share the preliminary results with VON teams participating in QI collaboratives and at the VON Annual Quality Congress.