SDx

The challenge

Children discharged from the hospital after treatment for a serious infection remain at increased risk of death for several months. In the six months following discharge, mortality rates are typically 5–10%, as high as they are when children are being treated for serious infections in hospitals.

Half of all deaths that occur within 6 months after discharge happen at home, without children receiving further hospital care, and half occur more than a month after discharge. Children living in poverty are at markedly higher risk of death.

It is not feasible for facility-based health workers to monitor discharged children for signs of deterioration or other serious illnesses. However, community health workers could link the community and hospitals, enabling the monitoring of high-risk children and their referral back to hospitals when necessary.

The project

The SDx team has developed a ‘Smart Discharge’ approach to hospital care, based on a digital algorithm integrated into electronic health records, that guides clinical decision-making based on infection severity. Analysing eight easily measured variables, the algorithm categorises children into low-, medium-, and high-risk groups, enabling tailored clinical care and discharge plans.

In a trial in six hospitals in Uganda, this approach reduced the mortality rate among children under 5 years of age by nearly a quarter after discharge. This figure could be reduced further if the monitoring of high-risk children were extended into the community after discharge. 

However, the digital platform used by community health workers (eCHIS) is different to the electronic health record system used in clinical facilities. The SDx team is therefore developing a new module for the eCHIS system to equip community health workers with information on high-risk children post-discharge, how to monitor them, and when to refer them back to the hospital. This module is being co-developed with community health workers and other stakeholders to ensure that it integrates into existing work practices. 

Following testing for usability, feasibility, and accessibility, an optimised version of the new module will be evaluated in a clinical trial, comparing the use of the new approach with existing post-discharge practices. The trial will focus on children up to 16 years of age discharged after treatment for a serious infection. The key success factor is whether the introduction of the module leads to reduced all-cause mortality at 6 months after discharge.

The trial will also assess various process metrics to gain insights into how the module is used and its impact on care provision. Impacts on community health worker knowledge will also be explored. 

The project also incorporates an economic evaluation, and a plan will be developed to promote the integration and continued use in routine care at the end of the trial, for example, by identifying ‘champions’ of the new technology.

Impact

The SDx project could have a significant impact on children's survival after hospital treatment. It will:

• Demonstrate whether a digital tool, embedded within a standard community health worker health information system, can enable continued monitoring of vulnerable children in the community after discharge from the hospital.
• Provide evidence of whether this community monitoring leads to timely referral of children back to the hospital and improves survival rates.
• Help caregivers identify signs of deterioration and the need for a return to the hospital.

The SDx project could leverage digital technologies to maintain care-system contact with children during one of the most vulnerable periods of their life, the months following discharge from the hospital, when they are at heightened risk of serious illness and death.