Hospital readmissions for newly discharged pediatric home mechanical ventilation patients

Kun, Sheila S.; Edwards, Jeffrey D.; Ward, Sally L. Davidson; Keens, Thomas G.

doi:10.1002/ppul.21536

Cited by 116 publications

(131 citation statements)

References 13 publications

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“…The rehospitalization rate was significantly higher before decannulation; the most frequent reason for rehospitalization was respiratory related, as previously described. 35,36 Although no other studies have addressed the rehospitalization rates for children with tracheostomy, before and after decannulation, several have found that children who are ventilator dependent at home have a higher risk of rehospitalization than other children. 11,12,[36][37][38][39] The decrease in readmission rate after decannulation may be secondary to removal of the tracheostomy, improvement in BPD, or both.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Children With Severe Bronchopulmonary Dysplasia Who Were Ventilator Dependent at Home

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Respiratory outcomes of patients with bronchopulmonary dysplasia (BPD) range from no oxygen requirement to chronic respiratory failure. Outcomes of least severe types of BPD are well described. Limited data exist on outcomes of patients with BPD-related chronic ventilator dependency. WHAT THIS STUDY ADDS:Along with a first estimation of the incidence of patients with severe BPD-related chronic respiratory failure who were dependent on positive pressure ventilation via tracheostomy at home, we describe their survival rate, liberation from positive pressure ventilation, and decannulation. abstract OBJECTIVE: To describe the incidence and outcomes of children with chronic respiratory failure secondary to severe bronchopulmonary dysplasia (BPD) on chronic positive pressure ventilation (PPV) via tracheostomy at home. METHODS:We retrospectively reviewed medical charts of patients with severe BPD who were PPV dependent at home and who were enrolled in a university-affiliated home ventilator program between 1984 and 2010. We excluded patients with other comorbidities that could contribute to the development of chronic respiratory failure. We reported the incidence of these children in Indiana and cumulative incidences of survival, liberation from PPV, and decannulation.RESULTS: Over 27 years, 628 children were cared for in our home ventilator program. Of these, 102 patients met inclusion criteria: 83 (81.4%) were alive and 19 (18.6%) were deceased. Sixty-nine patients (67.6%) were liberated from PPV, and 97.1% of them were weaned before their fifth birthday, with a median age at liberation of 24 months (interquartile range, 19-33). Similarly, 60 patients (58.8%) were decannulated, of which 96.7% completed this process before their sixth birthday, with a median age at decannulation of 37.5 months (interquartile range, 31.5-45). The incidence of children with chronic respiratory failure secondary to BPD who were PPVdependent at home in Indiana was 1.23 per 100 000 live births in 1984 and increased to 4.77 per 100 000 live births in 2010.CONCLUSIONS: Although extreme prematurity associated with severe BPD necessitating PPV at home carries significant risks of morbidity and mortality, successful liberation from mechanical ventilation and decannulation are likely to occur. Pediatrics 2013;132:e727-e734

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Section: Discussionmentioning

confidence: 99%

Outcomes of Children With Severe Bronchopulmonary Dysplasia Who Were Ventilator Dependent at Home

et al. 2013

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“…Within this highest-utilizing group (ie, $4 rehospitalizations), technology complications were present in 8.7% of all admissions. Kun et al 30 found that tracheostomy decannulation or obstruction and tracheitis were in 12% and 17% of readmissions in the year after discharge with home mechanical ventilation, respectively. Device complications were present in 8% of a randomly selected sample of 15-day readmissions of children with chronic illnesses from another center.…”

Section: Medical Technology Device Complicationsmentioning

confidence: 99%

Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

et al. 2014

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BACKGROUND AND OBJECTIVES: Children with medical complexity (CMC) account for disproportionately high hospital use, and it is unknown if hospitalizations may be prevented. Our objective was to summarize evidence from (1) studies characterizing potentially preventable hospitalizations in CMC and (2) interventions aiming to reduce such hospitalizations. METHODS:Our data sources include Medline, Cochrane Central Register of Controlled Trials, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases from their originations, and hand search of article bibliographies. Observational studies (n = 13) characterized potentially preventable hospitalizations, and experimental studies (n = 4) evaluated the efficacy of interventions to reduce them. Data were extracted on patient and family characteristics, medical complexity and preventable hospitalization indicators, hospitalization rates, costs, and days. Results of interventions were summarized by their effect on changes in hospital use. RESULTS:Preventable hospitalizations were measured in 3 ways: ambulatory care sensitive conditions, readmissions, or investigator-defined criteria. Postsurgical patients, those with neurologic disorders, and those with medical devices had higher preventable hospitalization rates, as did those with public insurance and nonwhite race/ethnicity. Passive smoke exposure, nonadherence to medications, and lack of follow-up after discharge were additional risks. Hospitalizations for ambulatory care sensitive conditions were less common in more complex patients. Patients receiving home visits, care coordination, chronic care-management, and continuity across settings had fewer preventable hospitalizations.CONCLUSIONS: There were a limited number of published studies. Measures for CMC and preventable hospitalizations were heterogeneous. Risk of bias was moderate due primarily to limited controlled experimental designs. Reductions in hospital use among CMC might be possible. Strategies should target primary drivers of preventable hospitalizations.

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“…1 For children discharged from subacute care and readmitted to acute care within 30 days, ventilator dependence was one of many factors associated with readmission. 11 Kun et al, 10 however, found no statistically signifi cant associations between demographic and clinical data with nonelective readmissions to acute care from home for children dependent on mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…3,6 For children newly dependent on invasive mechanical ventilation and discharged from the hospital, the 12-month incidence of nonelective readmission has been reported at 40%. 10 This is the fi rst study examining readmission to acute care from a postacute care hospital. A recent study identifying children with chronic complex conditions reported a 19% incidence of readmission to the referring acute care hospital within 30 days of a subacute hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

Unplanned Readmissions to Acute Care From a Pediatric Postacute Care Hospital: Incidence, Clinical Reasons, and Predictive Factors

O’Brien

Dumas

Nash

et al. 2015

Hospital Pediatrics

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KEY WORDS POTENTIAL CONFLICT OF INTEREST:The authors have indicated they have no potential confl icts of interest to disclose. abstract OBJECTIVE: To identify the incidence, clinical reasons, and predictive factors for unplanned readmissions to acute care from a pediatric postacute care hospital. METHODS:A retrospective cohort analysis of all discharges between October 1, 2011, and September 30, 2013 (n = 298), in 1 pediatric postacute care hospital was conducted. Descriptive statistics were used to summarize the incidence and assess the clinical reasons for all readmissions to an acute care hospital. Logistic regression was used to identify predictive factors of any unplanned readmission to an acute care hospital. RESULTS:Thirty percent of all postacute care hospital discharges were unplanned readmissions to an acute care hospital. The primary clinical reasons for unplanned readmissions to acute care were respiratory decompensation (54%) and infection (20%). Requiring invasive mechanical ventilation, being <1 year of age, and having a postacute care length of stay <30 days were the 3 predictive factors.CONCLUSIONS: This is the fi rst study to examine readmission to acute care from a postacute care hospital and to identify age, length of stay, and dependence on mechanical ventilation as predictive factors. Understanding which children are likely to require an unplanned readmission may allow providers to develop strategies to minimize this occurrence.

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Hospital readmissions for newly discharged pediatric home mechanical ventilation patients

Cited by 116 publications

References 13 publications

Outcomes of Children With Severe Bronchopulmonary Dysplasia Who Were Ventilator Dependent at Home

Outcomes of Children With Severe Bronchopulmonary Dysplasia Who Were Ventilator Dependent at Home

Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

Unplanned Readmissions to Acute Care From a Pediatric Postacute Care Hospital: Incidence, Clinical Reasons, and Predictive Factors

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