Novel neuropsychology school reintegration service for inpatients with neurological conditions: a quality improvement initiative

Many children who are admitted to pediatric hospitals with new, acute neurological conditions do not receive adequate support to help them reintegrate into school. Lack of communication between the hospital team and school may lead to safety problems, delayed return to school, academic challenges, increased mental health concerns, and/or delayed assessment for special education services. Our team used Quality Improvement (QI) methodology to establish an inpatient consult workflow by including neuropsychological consultation and school reintegration recommendations for inpatients with new (or unaddressed) cognitive and functional needs. Education was provided by the neuropsychology team to medical providers and therapy teams about the school reintegration process and workflow. Additional processes were put into place to ensure that consults were received and completed within an appropriate timeframe. In the first 12 months of implementation, our team successfully completed 36 consults. The percentage of completed consults that included school reintegration recommendations increased from 0% to 100% over the 12-month period. The diagnostic populations included stroke (33%), neuroimmune diagnoses (19%), cardiac arrest (11%), traumatic brain injury (11%), encephalitis (6%), and brain tumor/oncology patients (6%). Our team successfully implemented a consultant workflow aimed at providing school reintegration support. The implementation of a school-reintegration neuropsychology service was feasible and practical. Additional work is needed to demonstrate patient outcomes, improve individualized approaches to service provision, and analyze long-term sustainability across large service lines.