1
|
Holm KG, Weis J, Eg M, Nørgaard B, Sixtus C, Haslund-Thomsen H, Helena Hansson, Brødsgaard A, Ragnhild Maastrup. Pain assessment and treatment in hospitalized infants, children, and young people. J Child Health Care 2023:13674935231163399. [PMID: 36949670 DOI: 10.1177/13674935231163399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Pain in hospitalized infants, children, and young people (ICYP) is a well-known phenomenon but remains undertreated. This study aimed to examine documented pain management practices provided for ICYP and compare practices adopted in neonatal and pediatric units. This national retrospective multi-center study was conducted in 40 of the 42 Danish neonatal and pediatric units in November 2020. Data were collected from the medical records of ICYP admitted to a participating unit. We performed a total of 846 medical record audits of which pain was assessed in 51.9% of the ICYP. Pain assessment was documented for more infants (57.8%) than for children and young people (CYP) (47.4%) (p = 0.003). CYP more often received pain treatment (37.7%) than infants (6.9%, p < 0.0001) and more frequently had a pain treatment plan (50.8% versus 10.2%, p < 0.0001). Use of non-pharmacological treatment was documented for 6.3% of the ICYP. Our findings indicate that pain assessment is insufficiently documented in Danish neonatal and pediatric units. Among cases in which pain scores indicated that the patient had experienced pain, pain treatment was documented in a larger proportion of the pediatric population than in the neonatal population.
Collapse
Affiliation(s)
- Kristina G Holm
- Hans Christian Andersen Children's Hospital, 11286Odense University Hospital, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Janne Weis
- Neonatal and Toddler Intensive Care Unit, Rigshospitalet, 53146Copenhagen University Hospital, Denmark
| | - Marianne Eg
- Department of Paediatrics, Regional Hospital Viborg, Denmark
- The Centre for Research in Clinical Nursing, Viborg, Denmark
| | - Betty Nørgaard
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark
| | - Claus Sixtus
- Research Centre for Emergency Medicine, Emergency Department, 11297Aarhus University Hospital, Aarhus, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, 11297Aarhus University, Aarhus, Denmark
- Department of Paediatrics and Adolescent Medicine, 11297Aarhus University Hospital, Aarhus, Denmark
| | - Helle Haslund-Thomsen
- Clinical Nursing Research Unit, 11297Aalborg University Hospital, Aalborg, Denmark
- Department of Pediatrics, Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark
| | - Helena Hansson
- Department of Paediatric and Adolescent Medicine, 53146Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- 53146Copenhagen University, Copenhagen, Denmark
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine and Department of Gynecology and Obstetrics, 53146Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Denmark
- Department of Nursing Science, Institute of Public Health, Health, 11297Aarhus University, Aarhus, Denmark
| | - Ragnhild Maastrup
- Neonatal and Toddler Intensive Care Unit, Rigshospitalet, 53146Copenhagen University Hospital, Denmark
- Knowledge Center for Breastfeeding Infants with Special Needs, Interdisciplinary Research Unit, Department of Neonatology, 53146Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
2
|
Rasmussen MK, Clemensen J, Zachariassen G, Kidholm K, Brødsgaard A, Smith AC, Holm KG. Cost analysis of neonatal tele-homecare for preterm infants compared to hospital-based care. J Telemed Telecare 2019; 26:474-481. [DOI: 10.1177/1357633x19843753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction Neonatal homecare (NH) can be used to provide parents the opportunity of bringing cardiopulmonary-stable preterm infants home for tube feeding and the establishment of breastfeeding supported by neonatal nurses visiting the home. However, home visits can be challenging for hospitals covering large regions, and, therefore, regular neonatal hospital care has remained the first choice in Denmark. As an alternative to home visits, telehealth may be used to deliver NH. Thus, neonatal tele-homecare (NTH) was developed. Positive infant outcomes and the optimization of family-centred care have been described, but the costs of telehealth in the context of NH remain unknown. This study aims to assess the costs of NTH compared to regular neonatal hospital care, from the health service perspective. Methods The cost analysis was based on an observational study of NTH in Denmark (run from November 2015 to December 2016) and followed the Consolidated Health Economic Evaluation Reporting Standards. The intervention group were the families of preterm infants receiving NTH ( n = 96). The control group comprised a historic cohort of families with preterm infants, receiving standard care in the neonatal intensive care unit (NICU) ( n = 278). NTH infants and the historical group were categorized according to gestational age at birth at/under and over 32 weeks. The outcomes were NTH resource utilization, in-NICU hospital bed days, re-admissions and total costs on average per infant. The time horizon was from birth to discharge. Results The costs of NTH resource utilization were, on average, €695 per infant, and the total costs per infant, on average, were €12,200 and €4200 for infants at/under and over 32 weeks, respectively. The corresponding costs of the control group were €14,300 and €4400. The difference in total costs showed statistical significance for the group of infants under 32 weeks ( p < 0.001). Discussion The cost analysis showed that NTH was less costly compared to regular hospital care, especially for infants born with gestational age at/under 32 weeks. NTH is an appropriate model of care for preterm infants and their families, is clinically effective and less expensive than similar services delivered in the hospital.
Collapse
Affiliation(s)
- Maja K Rasmussen
- Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jane Clemensen
- Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Hans Christian Andersen Children’s Hospital Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children’s Hospital Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Anne Brødsgaard
- Department of Paediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anthony C Smith
- Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Kristina G Holm
- Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Hans Christian Andersen Children’s Hospital Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|