- This is Chris host with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr.
Mark Bergeron, medical Director
for Digital Health transformation,
and medical director for the Neonatal Virtual program care
program at Children's Minnesota.
He joins us today to discuss the health systems,
the kids experts at home monitoring program.
Dr. Bergeron, thank you so much
for being part of the podcast today.
- Hey, good morning Chris, and thanks for having me back.
- I know you've been on our podcast before,
but for those who may not be unfamiliar with you,
could you please introduce yourself
and tell us a bit about your background?
- Yeah, absolutely. So, I, uh, I, like you said,
I'm Mark Bergeron.
Uh, I'm medical director
for Digital Health Transformation at Children's Minnesota,
but I'm also a practicing neonatologist
and I've been at Children's, uh, Minnesota for, gosh,
just about 19 years.
Uh, uh, one of my duties is also as medical director
of our virtual care programs within
the neonatology division.
- As I mentioned, we're here to talk about the Kid Experts
at Home monitoring program.
So can you tell us how it develops and what program
or programs, if any, or uses models?
- Yeah, absolutely.
So just, uh, before we get started,
just a little bit about Children's Minnesota.
Our neonatology program, uh, is, uh, a vital resource, uh,
to our communities and region.
Um, and it's one of, it is the largest program in Minnesota
with a level four NICU
and two level three N ICUs plus, uh,
level two special care nurseries, um, making us one
of the biggest programs, uh, in the upper Midwest region.
Um, the kid Expert at Home Program, uh, kind
of came about as, you know, within our, our, uh,
our neonatology group, a sense of curiosity about, uh,
are there other care models that we should be exploring?
Um, and out of that,
and a, a real pinch for bed space
during respiratory surge months, uh, during winter,
we came up with this kind of early discharge program
where our kids go home, we are, uh,
rounding on them virtually.
Um, and they're still receiving, uh,
nasal gastric tube feedings administered by their parents.
And it, it's great
'cause it facilitates earlier discharge than what's
traditionally expected from a neonatology unit.
Um, and it, uh, gets these kids home where they should be.
- Certainly this is something that would need a bit
of training for both the
staff involved as well as the parents.
So what is involved in that process?
- Well, uh, from the first day ,
a baby is admitted to the neonatal units.
We're teaching the parents how to take care
of a preterm infant.
That doesn't change, but parents have time
and time again said that the, the slowest kind
of most frustrating part of the neonatal journey, uh,
to home is the last few weeks
and days when the infant has really no medical problems,
but just is slowly learning how to eat.
And so we sort of have modified our, uh,
discharge teaching for home process
to include tube feedings at home.
Traditionally, you would wait
until the infant had their feeding tube removed from their
nose and, and make sure they were gaining weight
and then discharge 'em to home.
We've sort of cut out that last part, uh,
from the hospital experience
and offered it to parents to do it at home.
So we teach them how to care for that, uh, nasogastric tube,
how to administer the feedings using a feeding pump.
Uh, we teach 'em how to use a, uh,
a monitoring application on a smartphone
or a pad to enter their daily weights,
their feeding volumes, um, their urine
and stool output, all those things
that we would be recording in the hospital
to make medical decisions.
And then we round virtually with the families, uh,
to make those decisions about
how the feedings are progressing, um,
and how soon to remove that, uh, feeding tube,
but doing it at home.
And then we teach the parents what to do if it comes out,
who to call, um, and support them that way.
- Gotcha. So can you describe this CASA program has had in
the Children's Minnesota community,
and are there plans to expand the program
beyond the three hospitals it currently serves?
- Yeah, absolutely. So I think, you know, we could,
it's been a resounding success.
It's shortened. Uh, you know, in our pilot study,
it shortened the expected hospital stay by about six days.
Uh, we saw the feedings, uh, uh, go better at home
as we kind of anticipated that they would,
and full oral feedings were established quicker at home
by several days, um, faster than
what we were experiencing traditionally in the hospital.
So we think those, those things are a resounding success.
We've had very few PE babies have to come back
for admission, uh, after discharge in the program.
And actually, in looking at those cases, they had nothing
to do with feedings and were other issues
that prompted the readmission to the hospital.
So we think it's successful, we think it's safe,
it's effective, and it's been a huge
satisfier for our families.
And during the height of Covid,
there was one patient in particular that struck us all, um,
and really characterizes the value of this program
that was Finn born at 32 weeks.
And, uh, during the height
of Covid when we were very restrictive about how many, uh,
visitors could come in, uh, uh, we had Finn
who was a perfect candidate for this program.
Uh, and his father was, uh, ending his, uh, battle with, uh,
pancreatic cancer and was not able to come
and see Finn in the hospital.
And we got Finn home quick on this program, uh,
and, uh, into where he should have been
with his, his parents.
And then, uh, his father ultimately passed away, uh,
not long after Finn's feeding Tube was removed,
and he was thriving at home.
And for, for all of us involved in his care, this was a win.
This was just a, a tremendous impact to our families
that we serve on, especially fins.
- Yeah. Wow. Dr. Bergan,
that's certainly a heartbreaking story,
but heartwarming in the fact that the father did get
to see his son for a little bit before he died.
I mean, wow. Yeah. Yeah.
Thankfully, yes, there are times when
that is considered a victory.
- Yeah. And, uh, so we want every family to, to have
that experience of getting their, their infant home as soon
as possible and, and thrive, uh, and, uh,
and we think that this is a great way to do that.
- Lastly, Dr. Bergon, it's a bit of a two part question.
Sure. So, what do you think is the next evolution
for kid experts at home?
And what other innovations does Children's Minnesota help
hope to launch in 2024 or the next few years?
- So we want as many babies to be, uh, suitable for this
or the program to be suitable for them as possible.
And the limitations of the technology
that we had when we launched the program was
that it was the, the application was
available in English only.
So we're now expanding that to Spanish.
And we we're working with our app vendor
to increase the number of languages offered.
Um, we use our own interpreter services for the, um,
virtual visits, but we want that app to be in, in, uh,
a usable language and format for all of our families.
So from an equity lens, that's probably our primary, uh,
focus, uh, this year.
And then, uh, we want the service to be more, you know, uh,
add value to our family's experience.
So we are adding virtual, uh, lactation consultations in
the kid expert at home program.
So one of our pediatric nurse practitioners
that works in our special care nursery will have virtual
visits, uh, with, um, uh, moms and their babies
after discharge to work on the lactation piece.
Um, so that we're really sending babies home with, uh,
successful, uh, breastfeeding, um, as a goal
and, uh, something that they can achieve.
And then looking into the future, we kind
of see the kid expert at home program as, as kind
of an early form of the hospital at home concept
that has been so wildly successful in the adult population.
And so, you know,
I guess in our journey towards a hospital at home care
model, this is our, our first baby step,
if you will, towards that.
Um, and really looking at other patients at Children's
Minnesota that could be suitable for, uh, um, kind
of a more advanced care at home.
- Dr. Berg, thank you so much for being so generous
with your time and insights today.
We definitely cannot wait to share them with our audience.
We look forward to connecting with you again soon.
- Hey, thanks Chris. I always appreciate the,
uh, opportunity to chat with you.
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