Table 5 Key findings from feedback of parents, trainees, physicians

Randomization

Randomization can be done; one possibility is to examine play activities, with and without parental coaching stratified by disease groups as either acute or complex. Another possibility is to ranomized groups for follow-up support post-discharge. A group with no intervention will not be possible as all children/families will be offered this service upon admission into the ward and withholding will be unethical.

Intervention implementation

Dedicated senior staff are required to oversee the execution of the program and follow a formalized process of monitoring and evaluation as planned for quarterly meetings. Though started as a pilot service, the program evolved very quickly and staff were stretched thin to incorporate regular feedback and changes.

Intervention content

No change is recommended for the content. One addition can be to encourage special education services for children with prolonged stay or repeated admissions.

Intervention mode

Individual bedside sessions are feasible, particularly compared to groups, due to space constraints and privacy concerns. Groups also enhance risk of infection.

Intervention delivery staff

Students, preferably enroled in Master’s programmes are suitable for the intervention delivery. Undergraduates can be utilized but not as core delivery staff.

Intervention delivery forms

The content needs simplification and length of forms needs to be reduced. An additional form is required for quick screening of developmental and emotional issues to help trainees frame their intervention plan. The forms need to be co-designed with the key stakeholder who will use the data, e.g. physicians for child health outcomes and university supervisors for academic outcomes of the trainees.

Engaging trainee students

Continue to share reports with university management. Make more efforts to engage university supervisors through in-person meetings. It is an important aspect to assure quality and professionalism by students while imparting a sense of accountability. Ideally, after every rotation so lessons learnt from one should be incorporated into the next rotation.

Engaging physicians

Individual reports are very time-consuming and feedback on emails may not always be received. Having in-person monthly meetings while sharing trends with physicians aggregated by disease groups can be more effective. Incorporate their feedback into the on-going programme.

Continuation of services for children

Children with additional needs should be identified during the intervention and connected for out-patient follow-up.

Evaluation

Resources are needed for meeting families post-discharge and collecting their insights about the intervention. Meeting minutes with university supervisors and physicians can also add to the process evaluation of the intervention. A log of supervisor observations can be maintained covering their weekly in-depth meetings and rounds. To determine effectiveness, a trial is recommended.