P2A223: Feasibility of Implementing a Virtual Pediatric Critical Care Follow-up Clinic

Background: With marked improvements in PICU mortality, there are increasing numbers of patients surviving to discharge with significant co-morbidities. Given the vulnerable stage patients are in their growth and development, there is an urgent need to identify the cognitive, physical, and mental health impairments that occur post-discharge. Research shows that socioeconomic and racial differences are related to worse outcomes in child survivors, thus focus on catching the most at-risk population is of utmost importance. It is possible that those risk factors that make patients less likely to adhere to follow-up appointments also put them at higher risk for poor outcomes.

With an aim of further evaluating this, we first sought a process to increase accessibility to PICU follow-up clinics. It has been shown that telemedicine community clinics are associated with fewer missed appointments, particularly in chronic patients and those in metropolitan areas. Here we describe the feasibility and process of establishing a virtual post-discharge PICU clinic for patients with length of stay >72 hours with an initial pilot over two months.

Methods: The pilot phase ran from October 2022 to January 2023. Divisional and departmental buy-in was obtained. A virtual clinic was created within Epic occurring bi-monthly. All patients with length of stay >72 hours were approached by our clinical case manager. Those patients that expressed interest were contacted by an administrator and appointments were made. All patients were seen by a single PICU fellow and attending. During the visit, patients were screened for physical health, mental health, cognition, impact on family and social determinants of health. Social work referrals were made when appropriate.

Results: Thirty patients were approached, with 57% scheduling follow-up (n=17/30). Of those that scheduled, 41% (n=7) attended while 59% (n=10) did not attend (Fig. 1). As a proxy for socioeconomic differences, we looked at median household income based on address. Our patients who did attend clinic had a median income of $68370 (IQR $23674), compared to patients who did not attend with median of $88612 (IQR $41694, p-value = 0.41, not significant). Utilizing the childhood opportunity index, we found that of the eligible patients, 63% (n=19/30) were classified as low/very low SES compared to 58% of those who scheduled (n=10/17) and 43% (n=3/7) of those who attended clinic.

Conclusion: We aimed to understand how the structure of a follow-up clinic is utilized with our patient population, and to apply our strategy for real-time modification of our approach to ensure equitable opportunities and access. It is possible that the virtual venue for this clinic increases accessibility for those of lower socioeconomic status and demonstrates feasibility for capturing these at-risk patients. Further steps include continuing to build our program and assessing SDOH as predictors of compliance and long-term outcomes.