Hospital to Home Transitions for Children With Medical Complexity: A Scoping Review of Healthcare Professionals Experiences

Abstract

Background

Hospital-to-home (H2H) transitions for children with medical complexity (CMC) are challenging and time-intensive, often overwhelming parents due to insufficient care coordination, poor communication among healthcare professionals (HCPs), and limited family education. These shortcomings impact children, families and HCPs alike, highlighting the urgent need for improve H2H care for CMC. A key knowledge gap concerns HCP perspectives, as they play a pivotal role in ensuring care aligns with family needs.

Objective

To synthesize HCP needs, views and experiences with H2H transitions for CMC and inform optimized care strategies.

Eligibility Criteria

Eligible studies were peer-reviewed original research on HCP experiences with H2H transitions for CMC, without restrictions on healthcare setting, publication year or study design.

Data Sources

Systematic searches were conducted in MEDLINE, Embase, PsycINFO and CINAHL through July 2024.

Data Extraction and Analysis

Two independent reviewers screened studies using predefined inclusion criteria. Study characteristics and HCP perspectives were extracted using a piloted form. Qualitative content analysis was used to synthesize HCP experiences. The resulting themes were organized using the socio-ecological model, which describes elements at individual, interpersonal, organizational, community and societal levels.

Results

Of 4087 identified records, 40 reports met eligibility criteria. Eleven themes were identified, with care coordination and continuity challenges spanning all socio-ecological levels. Key challenges included HCP knowledge gaps and emotional burden (individual level), strained communication with parents and among HCPs (interpersonal level), inadequate care and educational plans (organizational level), restricted resources (community level) and bureaucratic hurdles (society level).

Conclusion

This scoping review identifies multi-level challenges HCPs face in supporting H2H transitions for CMC. The findings can guide the development of supportive interventions and healthcare innovations to strengthen care coordination, professional preparation, and cross-setting collaboration. In addition, they provide direction for future targeted research.

Summary

• This scoping review synthesizes healthcare professionals' experiences from 40 international studies, identifying 11 key themes structured within the socio-ecological model. This offers a comprehensive framework to understand and improve hospital-to-home transitional care for children with medical complexity.
• The findings can guide the development of supportive interventions, including care coordination programs, structured education for families and professionals, and transitional care units.
• Further research is needed to evaluate the effectiveness, feasibility, and contextual adaptability of transitional care interventions, and to strengthen interprofessional collaboration across hospital and community settings.