1 00:00:00,120 --> 00:00:02,405 - This is Chris host with the Becker's Healthcare Podcast. 2 00:00:03,145 --> 00:00:04,645 I'm thrilled today to be joined by Dr. 3 00:00:04,675 --> 00:00:06,685 Mark Bergeron, medical Director 4 00:00:06,705 --> 00:00:08,325 for Digital Health transformation, 5 00:00:08,665 --> 00:00:11,885 and medical director for the Neonatal Virtual program care 6 00:00:11,885 --> 00:00:13,405 program at Children's Minnesota. 7 00:00:13,785 --> 00:00:15,725 He joins us today to discuss the health systems, 8 00:00:15,745 --> 00:00:17,685 the kids experts at home monitoring program. 9 00:00:18,265 --> 00:00:19,565 Dr. Bergeron, thank you so much 10 00:00:19,605 --> 00:00:20,885 for being part of the podcast today. 11 00:00:22,235 --> 00:00:24,175 - Hey, good morning Chris, and thanks for having me back. 12 00:00:25,175 --> 00:00:26,735 - I know you've been on our podcast before, 13 00:00:26,795 --> 00:00:29,655 but for those who may not be unfamiliar with you, 14 00:00:29,655 --> 00:00:30,975 could you please introduce yourself 15 00:00:30,975 --> 00:00:32,295 and tell us a bit about your background? 16 00:00:33,115 --> 00:00:36,125 - Yeah, absolutely. So, I, uh, I, like you said, 17 00:00:36,145 --> 00:00:37,205 I'm Mark Bergeron. 18 00:00:37,425 --> 00:00:38,805 Uh, I'm medical director 19 00:00:38,965 --> 00:00:41,365 for Digital Health Transformation at Children's Minnesota, 20 00:00:41,365 --> 00:00:43,245 but I'm also a practicing neonatologist 21 00:00:43,665 --> 00:00:46,645 and I've been at Children's, uh, Minnesota for, gosh, 22 00:00:46,645 --> 00:00:47,645 just about 19 years. 23 00:00:48,265 --> 00:00:51,445 Uh, uh, one of my duties is also as medical director 24 00:00:51,445 --> 00:00:53,085 of our virtual care programs within 25 00:00:53,105 --> 00:00:54,325 the neonatology division. 26 00:00:56,705 --> 00:00:59,085 - As I mentioned, we're here to talk about the Kid Experts 27 00:00:59,145 --> 00:01:00,485 at Home monitoring program. 28 00:01:00,945 --> 00:01:02,965 So can you tell us how it develops and what program 29 00:01:03,505 --> 00:01:05,605 or programs, if any, or uses models? 30 00:01:07,145 --> 00:01:08,275 - Yeah, absolutely. 31 00:01:08,335 --> 00:01:09,795 So just, uh, before we get started, 32 00:01:09,795 --> 00:01:11,475 just a little bit about Children's Minnesota. 33 00:01:11,495 --> 00:01:15,755 Our neonatology program, uh, is, uh, a vital resource, uh, 34 00:01:15,775 --> 00:01:17,595 to our communities and region. 35 00:01:18,015 --> 00:01:21,755 Um, and it's one of, it is the largest program in Minnesota 36 00:01:21,865 --> 00:01:23,795 with a level four NICU 37 00:01:23,935 --> 00:01:27,115 and two level three N ICUs plus, uh, 38 00:01:27,115 --> 00:01:30,595 level two special care nurseries, um, making us one 39 00:01:30,595 --> 00:01:34,035 of the biggest programs, uh, in the upper Midwest region. 40 00:01:34,695 --> 00:01:39,515 Um, the kid Expert at Home Program, uh, kind 41 00:01:39,515 --> 00:01:42,835 of came about as, you know, within our, our, uh, 42 00:01:43,095 --> 00:01:46,595 our neonatology group, a sense of curiosity about, uh, 43 00:01:46,935 --> 00:01:49,795 are there other care models that we should be exploring? 44 00:01:50,375 --> 00:01:52,435 Um, and out of that, 45 00:01:52,615 --> 00:01:55,315 and a, a real pinch for bed space 46 00:01:55,335 --> 00:01:58,675 during respiratory surge months, uh, during winter, 47 00:01:58,975 --> 00:02:01,835 we came up with this kind of early discharge program 48 00:02:02,045 --> 00:02:04,795 where our kids go home, we are, uh, 49 00:02:04,795 --> 00:02:05,995 rounding on them virtually. 50 00:02:06,375 --> 00:02:08,075 Um, and they're still receiving, uh, 51 00:02:08,165 --> 00:02:11,395 nasal gastric tube feedings administered by their parents. 52 00:02:11,735 --> 00:02:12,795 And it, it's great 53 00:02:12,915 --> 00:02:15,795 'cause it facilitates earlier discharge than what's 54 00:02:15,795 --> 00:02:19,235 traditionally expected from a neonatology unit. 55 00:02:19,535 --> 00:02:22,795 Um, and it, uh, gets these kids home where they should be. 56 00:02:24,285 --> 00:02:27,015 - Certainly this is something that would need a bit 57 00:02:27,015 --> 00:02:28,335 of training for both the 58 00:02:28,335 --> 00:02:29,855 staff involved as well as the parents. 59 00:02:29,915 --> 00:02:31,215 So what is involved in that process? 60 00:02:32,665 --> 00:02:36,745 - Well, uh, from the first day , 61 00:02:37,065 --> 00:02:39,065 a baby is admitted to the neonatal units. 62 00:02:39,155 --> 00:02:40,705 We're teaching the parents how to take care 63 00:02:40,705 --> 00:02:41,825 of a preterm infant. 64 00:02:42,215 --> 00:02:45,185 That doesn't change, but parents have time 65 00:02:45,245 --> 00:02:48,705 and time again said that the, the slowest kind 66 00:02:48,705 --> 00:02:52,945 of most frustrating part of the neonatal journey, uh, 67 00:02:52,965 --> 00:02:55,745 to home is the last few weeks 68 00:02:55,885 --> 00:03:00,045 and days when the infant has really no medical problems, 69 00:03:00,225 --> 00:03:03,205 but just is slowly learning how to eat. 70 00:03:03,825 --> 00:03:07,965 And so we sort of have modified our, uh, 71 00:03:08,075 --> 00:03:10,365 discharge teaching for home process 72 00:03:10,625 --> 00:03:12,765 to include tube feedings at home. 73 00:03:12,795 --> 00:03:14,205 Traditionally, you would wait 74 00:03:14,205 --> 00:03:16,485 until the infant had their feeding tube removed from their 75 00:03:16,485 --> 00:03:18,685 nose and, and make sure they were gaining weight 76 00:03:18,685 --> 00:03:19,965 and then discharge 'em to home. 77 00:03:20,295 --> 00:03:23,285 We've sort of cut out that last part, uh, 78 00:03:23,355 --> 00:03:24,685 from the hospital experience 79 00:03:24,865 --> 00:03:27,125 and offered it to parents to do it at home. 80 00:03:27,265 --> 00:03:30,965 So we teach them how to care for that, uh, nasogastric tube, 81 00:03:31,105 --> 00:03:33,445 how to administer the feedings using a feeding pump. 82 00:03:34,185 --> 00:03:36,365 Uh, we teach 'em how to use a, uh, 83 00:03:36,725 --> 00:03:39,805 a monitoring application on a smartphone 84 00:03:39,945 --> 00:03:42,685 or a pad to enter their daily weights, 85 00:03:42,685 --> 00:03:45,005 their feeding volumes, um, their urine 86 00:03:45,105 --> 00:03:47,125 and stool output, all those things 87 00:03:47,125 --> 00:03:48,685 that we would be recording in the hospital 88 00:03:48,785 --> 00:03:49,845 to make medical decisions. 89 00:03:49,845 --> 00:03:52,725 And then we round virtually with the families, uh, 90 00:03:52,745 --> 00:03:54,565 to make those decisions about 91 00:03:55,425 --> 00:03:57,445 how the feedings are progressing, um, 92 00:03:57,745 --> 00:04:00,285 and how soon to remove that, uh, feeding tube, 93 00:04:00,585 --> 00:04:02,005 but doing it at home. 94 00:04:02,305 --> 00:04:04,285 And then we teach the parents what to do if it comes out, 95 00:04:04,345 --> 00:04:06,685 who to call, um, and support them that way. 96 00:04:09,135 --> 00:04:11,995 - Gotcha. So can you describe this CASA program has had in 97 00:04:12,095 --> 00:04:13,955 the Children's Minnesota community, 98 00:04:14,295 --> 00:04:15,955 and are there plans to expand the program 99 00:04:15,955 --> 00:04:17,995 beyond the three hospitals it currently serves? 100 00:04:18,945 --> 00:04:21,555 - Yeah, absolutely. So I think, you know, we could, 101 00:04:22,105 --> 00:04:23,595 it's been a resounding success. 102 00:04:23,825 --> 00:04:26,555 It's shortened. Uh, you know, in our pilot study, 103 00:04:26,575 --> 00:04:29,555 it shortened the expected hospital stay by about six days. 104 00:04:30,215 --> 00:04:34,595 Uh, we saw the feedings, uh, uh, go better at home 105 00:04:34,775 --> 00:04:36,595 as we kind of anticipated that they would, 106 00:04:36,655 --> 00:04:40,475 and full oral feedings were established quicker at home 107 00:04:40,495 --> 00:04:43,275 by several days, um, faster than 108 00:04:43,275 --> 00:04:45,595 what we were experiencing traditionally in the hospital. 109 00:04:45,695 --> 00:04:48,195 So we think those, those things are a resounding success. 110 00:04:48,365 --> 00:04:51,275 We've had very few PE babies have to come back 111 00:04:51,455 --> 00:04:54,275 for admission, uh, after discharge in the program. 112 00:04:54,735 --> 00:04:57,595 And actually, in looking at those cases, they had nothing 113 00:04:57,595 --> 00:04:59,435 to do with feedings and were other issues 114 00:04:59,465 --> 00:05:01,395 that prompted the readmission to the hospital. 115 00:05:01,575 --> 00:05:04,275 So we think it's successful, we think it's safe, 116 00:05:04,425 --> 00:05:05,755 it's effective, and it's been a huge 117 00:05:05,785 --> 00:05:07,635 satisfier for our families. 118 00:05:07,815 --> 00:05:09,435 And during the height of Covid, 119 00:05:09,485 --> 00:05:13,675 there was one patient in particular that struck us all, um, 120 00:05:13,975 --> 00:05:16,075 and really characterizes the value of this program 121 00:05:16,185 --> 00:05:18,075 that was Finn born at 32 weeks. 122 00:05:18,415 --> 00:05:20,195 And, uh, during the height 123 00:05:20,195 --> 00:05:23,115 of Covid when we were very restrictive about how many, uh, 124 00:05:23,315 --> 00:05:26,035 visitors could come in, uh, uh, we had Finn 125 00:05:26,455 --> 00:05:29,115 who was a perfect candidate for this program. 126 00:05:29,735 --> 00:05:34,595 Uh, and his father was, uh, ending his, uh, battle with, uh, 127 00:05:34,595 --> 00:05:36,795 pancreatic cancer and was not able to come 128 00:05:36,795 --> 00:05:37,915 and see Finn in the hospital. 129 00:05:38,255 --> 00:05:42,235 And we got Finn home quick on this program, uh, 130 00:05:42,495 --> 00:05:44,755 and, uh, into where he should have been 131 00:05:44,755 --> 00:05:45,835 with his, his parents. 132 00:05:46,015 --> 00:05:49,395 And then, uh, his father ultimately passed away, uh, 133 00:05:49,455 --> 00:05:51,915 not long after Finn's feeding Tube was removed, 134 00:05:51,915 --> 00:05:53,115 and he was thriving at home. 135 00:05:53,295 --> 00:05:57,205 And for, for all of us involved in his care, this was a win. 136 00:05:57,435 --> 00:06:01,205 This was just a, a tremendous impact to our families 137 00:06:01,205 --> 00:06:03,405 that we serve on, especially fins. 138 00:06:04,925 --> 00:06:06,255 - Yeah. Wow. Dr. Bergan, 139 00:06:06,255 --> 00:06:08,135 that's certainly a heartbreaking story, 140 00:06:08,195 --> 00:06:10,855 but heartwarming in the fact that the father did get 141 00:06:10,855 --> 00:06:12,535 to see his son for a little bit before he died. 142 00:06:12,655 --> 00:06:13,855 I mean, wow. Yeah. Yeah. 143 00:06:14,225 --> 00:06:16,535 Thankfully, yes, there are times when 144 00:06:16,535 --> 00:06:17,775 that is considered a victory. 145 00:06:18,765 --> 00:06:21,855 - Yeah. And, uh, so we want every family to, to have 146 00:06:21,855 --> 00:06:24,655 that experience of getting their, their infant home as soon 147 00:06:24,655 --> 00:06:27,895 as possible and, and thrive, uh, and, uh, 148 00:06:28,035 --> 00:06:29,855 and we think that this is a great way to do that. 149 00:06:31,445 --> 00:06:33,825 - Lastly, Dr. Bergon, it's a bit of a two part question. 150 00:06:33,935 --> 00:06:36,225 Sure. So, what do you think is the next evolution 151 00:06:36,285 --> 00:06:37,425 for kid experts at home? 152 00:06:38,005 --> 00:06:40,505 And what other innovations does Children's Minnesota help 153 00:06:40,535 --> 00:06:43,225 hope to launch in 2024 or the next few years? 154 00:06:44,675 --> 00:06:48,895 - So we want as many babies to be, uh, suitable for this 155 00:06:48,915 --> 00:06:51,375 or the program to be suitable for them as possible. 156 00:06:51,555 --> 00:06:53,895 And the limitations of the technology 157 00:06:53,895 --> 00:06:55,895 that we had when we launched the program was 158 00:06:55,895 --> 00:06:57,655 that it was the, the application was 159 00:06:57,655 --> 00:06:58,735 available in English only. 160 00:06:58,835 --> 00:07:00,935 So we're now expanding that to Spanish. 161 00:07:01,075 --> 00:07:03,095 And we we're working with our app vendor 162 00:07:03,275 --> 00:07:05,575 to increase the number of languages offered. 163 00:07:05,955 --> 00:07:08,775 Um, we use our own interpreter services for the, um, 164 00:07:08,925 --> 00:07:12,655 virtual visits, but we want that app to be in, in, uh, 165 00:07:12,935 --> 00:07:15,615 a usable language and format for all of our families. 166 00:07:15,615 --> 00:07:19,415 So from an equity lens, that's probably our primary, uh, 167 00:07:19,465 --> 00:07:21,175 focus, uh, this year. 168 00:07:21,875 --> 00:07:25,615 And then, uh, we want the service to be more, you know, uh, 169 00:07:25,715 --> 00:07:27,895 add value to our family's experience. 170 00:07:27,955 --> 00:07:31,855 So we are adding virtual, uh, lactation consultations in 171 00:07:32,395 --> 00:07:33,695 the kid expert at home program. 172 00:07:33,835 --> 00:07:36,135 So one of our pediatric nurse practitioners 173 00:07:36,285 --> 00:07:38,855 that works in our special care nursery will have virtual 174 00:07:38,875 --> 00:07:41,855 visits, uh, with, um, uh, moms and their babies 175 00:07:41,985 --> 00:07:44,815 after discharge to work on the lactation piece. 176 00:07:45,035 --> 00:07:48,015 Um, so that we're really sending babies home with, uh, 177 00:07:48,305 --> 00:07:51,375 successful, uh, breastfeeding, um, as a goal 178 00:07:51,515 --> 00:07:53,375 and, uh, something that they can achieve. 179 00:07:54,075 --> 00:07:56,455 And then looking into the future, we kind 180 00:07:56,455 --> 00:07:59,815 of see the kid expert at home program as, as kind 181 00:07:59,815 --> 00:08:03,775 of an early form of the hospital at home concept 182 00:08:03,845 --> 00:08:07,255 that has been so wildly successful in the adult population. 183 00:08:07,835 --> 00:08:08,895 And so, you know, 184 00:08:09,775 --> 00:08:12,415 I guess in our journey towards a hospital at home care 185 00:08:12,425 --> 00:08:14,655 model, this is our, our first baby step, 186 00:08:14,755 --> 00:08:15,895 if you will, towards that. 187 00:08:16,115 --> 00:08:18,375 Um, and really looking at other patients at Children's 188 00:08:18,535 --> 00:08:22,135 Minnesota that could be suitable for, uh, um, kind 189 00:08:22,135 --> 00:08:23,535 of a more advanced care at home. 190 00:08:26,185 --> 00:08:28,485 - Dr. Berg, thank you so much for being so generous 191 00:08:28,485 --> 00:08:29,885 with your time and insights today. 192 00:08:29,945 --> 00:08:32,165 We definitely cannot wait to share them with our audience. 193 00:08:32,345 --> 00:08:34,045 We look forward to connecting with you again soon. 194 00:08:34,805 --> 00:08:36,665 - Hey, thanks Chris. I always appreciate the, 195 00:08:36,665 --> 00:08:37,785 uh, opportunity to chat with you. 196 00:08:40,415 --> 00:08:42,905 - It's so important for leaders at the top of organizations 197 00:08:42,905 --> 00:08:45,345 to keep learning, stay sharp, grow their networks, 198 00:08:45,815 --> 00:08:48,385 help our audience better do this in a more simplified, 199 00:08:48,385 --> 00:08:50,065 personalized, and meaningful way. 200 00:08:50,625 --> 00:08:53,105 Becker's Healthcare has launched my BHC, 201 00:08:53,575 --> 00:08:55,605 it's your trusted Becker's healthcare experience 202 00:08:55,605 --> 00:08:57,805 and more with content, connections, events 203 00:08:57,825 --> 00:08:58,845 and learning opportunities. 204 00:08:59,555 --> 00:09:00,645 Join the community free 205 00:09:00,645 --> 00:09:05,445 of charge@www.my dot becker's hospital review.com 206 00:09:05,545 --> 00:09:06,365 and we'll see you there.