Abstract
Objective: To assess the reasons for discharge delays for children with long-term mechanical ventilation. Study design: Charts of children (0-18 years of age) with a new tracheostomy in the Pulmonary Habilitation Program at the Ann and Robert H. Lurie Children's Hospital of Chicago were retrospectively reviewed for demographic information, medical diagnoses, medical stability, discharge to home, reasons for discharge delay, and hours of staffed home nursing. All patients were discharged on mechanical ventilation. Discharge delay was defined as >10 days after medical stability. Hospital charges were analyzed and excess charges quantified beginning with the date of delay. Descriptive statistics and Pearson χ2 tests were used to compare nursing hours and demographics. Results: Of 72 patients, 55% were male with mean age 1.8 years (SD 3.8) at tracheostomy placement. The most common long-term mechanical ventilation indication was chronic lung disease (n = 47, 65%); 54% had discharge delays, the majority were primarily due to lack of home nursing (62%), followed by delay of caregiver training (18%), caregiver health and social issues (8%), and delay in a transitional care facility bed (8%). Of the 39 delayed patients, 10% ($13 217 889) of hospital charges occurred during excess days with a median of $186 061 (IQR $117 661-$386 905) per patient. Conclusions: Over one-half of children discharged to the community from a large inpatient pediatric long-term mechanical ventilation program had a nonmedical delay of discharge home, most commonly because of home nurse staffing. This case series provides further evidence that limited availability of home nursing impedes efficient discharge and prolongs hospitalizations.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 166-171 |
| Number of pages | 6 |
| Journal | Journal of Pediatrics |
| Volume | 212 |
| DOIs | |
| State | Published - Sep 1 2019 |
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Keywords
- children with long-term mechanical ventilation
- home healthcare
- hospital discharge
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
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Attributable Delay of Discharge for Children with Long-Term Mechanical Ventilation. / Sobotka, Sarah A.; Foster, Carolyn Christine; Lynch, Emma; Hird-McCorry, Lindsey; Goodman, Denise M.
In: Journal of Pediatrics, Vol. 212, 01.09.2019, p. 166-171.Research output: Contribution to journal › Article
TY - JOUR
T1 - Attributable Delay of Discharge for Children with Long-Term Mechanical Ventilation
AU - Sobotka, Sarah A.
AU - Foster, Carolyn Christine
AU - Lynch, Emma
AU - Hird-McCorry, Lindsey
AU - Goodman, Denise M
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Objective: To assess the reasons for discharge delays for children with long-term mechanical ventilation. Study design: Charts of children (0-18 years of age) with a new tracheostomy in the Pulmonary Habilitation Program at the Ann and Robert H. Lurie Children's Hospital of Chicago were retrospectively reviewed for demographic information, medical diagnoses, medical stability, discharge to home, reasons for discharge delay, and hours of staffed home nursing. All patients were discharged on mechanical ventilation. Discharge delay was defined as >10 days after medical stability. Hospital charges were analyzed and excess charges quantified beginning with the date of delay. Descriptive statistics and Pearson χ2 tests were used to compare nursing hours and demographics. Results: Of 72 patients, 55% were male with mean age 1.8 years (SD 3.8) at tracheostomy placement. The most common long-term mechanical ventilation indication was chronic lung disease (n = 47, 65%); 54% had discharge delays, the majority were primarily due to lack of home nursing (62%), followed by delay of caregiver training (18%), caregiver health and social issues (8%), and delay in a transitional care facility bed (8%). Of the 39 delayed patients, 10% ($13 217 889) of hospital charges occurred during excess days with a median of $186 061 (IQR $117 661-$386 905) per patient. Conclusions: Over one-half of children discharged to the community from a large inpatient pediatric long-term mechanical ventilation program had a nonmedical delay of discharge home, most commonly because of home nurse staffing. This case series provides further evidence that limited availability of home nursing impedes efficient discharge and prolongs hospitalizations.
AB - Objective: To assess the reasons for discharge delays for children with long-term mechanical ventilation. Study design: Charts of children (0-18 years of age) with a new tracheostomy in the Pulmonary Habilitation Program at the Ann and Robert H. Lurie Children's Hospital of Chicago were retrospectively reviewed for demographic information, medical diagnoses, medical stability, discharge to home, reasons for discharge delay, and hours of staffed home nursing. All patients were discharged on mechanical ventilation. Discharge delay was defined as >10 days after medical stability. Hospital charges were analyzed and excess charges quantified beginning with the date of delay. Descriptive statistics and Pearson χ2 tests were used to compare nursing hours and demographics. Results: Of 72 patients, 55% were male with mean age 1.8 years (SD 3.8) at tracheostomy placement. The most common long-term mechanical ventilation indication was chronic lung disease (n = 47, 65%); 54% had discharge delays, the majority were primarily due to lack of home nursing (62%), followed by delay of caregiver training (18%), caregiver health and social issues (8%), and delay in a transitional care facility bed (8%). Of the 39 delayed patients, 10% ($13 217 889) of hospital charges occurred during excess days with a median of $186 061 (IQR $117 661-$386 905) per patient. Conclusions: Over one-half of children discharged to the community from a large inpatient pediatric long-term mechanical ventilation program had a nonmedical delay of discharge home, most commonly because of home nurse staffing. This case series provides further evidence that limited availability of home nursing impedes efficient discharge and prolongs hospitalizations.
KW - children with long-term mechanical ventilation
KW - home healthcare
KW - hospital discharge
UR - http://www.scopus.com/inward/record.url?scp=85066267396&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85066267396&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2019.04.034
DO - 10.1016/j.jpeds.2019.04.034
M3 - Article
C2 - 31153586
AN - SCOPUS:85066267396
VL - 212
SP - 166
EP - 171
JO - Journal of Pediatrics
JF - Journal of Pediatrics
SN - 0022-3476
ER -