Prolonged Hospital Discharge for Children with Technology Dependency: A Source of Health Care Disparities

Sobotka, Sarah A.; Agrawal, Rishi; Msall, Michael E.

doi:10.3928/19382359-20170919-01

Cited by 19 publications

(17 citation statements)

References 21 publications

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“…This category included initiatives that altered how usual care was delivered. 51–55 63–66 68–92 Common practice change initiatives included hospital-based, nurse-led discharges and cross-sectoral transitional programmes (eg, Home First, Discharge to Assess, Hospital to Home). Most were implemented by nurses and multidisciplinary teams.…”

Section: Resultsmentioning

confidence: 99%

Initiatives for improving delayed discharge from a hospital setting: a scoping review

et al. 2021

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ObjectiveThe overarching objective of the scoping review was to examine peer reviewed and grey literature for best practices that have been developed, implemented and/or evaluated for delayed discharge involving a hospital setting. Two specific objectives were to review what the delayed discharge initiatives entailed and identify gaps in the literature in order to inform future work.DesignScoping review.MethodsElectronic databases and websites of government and healthcare organisations were searched for eligible articles. Articles were required to include an initiative that focused on delayed discharge, involve a hospital setting and be published between 1 January 2004 and 16 August 2019. Data were extracted using Microsoft Excel. Following extraction, a policy framework by Doern and Phidd was adapted to organise the included initiatives into categories: (1) information sharing; (2) tools and guidelines; (3) practice changes; (4) infrastructure and finance and (5) other.ResultsSixty-six articles were included in this review. The majority of initiatives were categorised as practice change (n=36), followed by information sharing (n=19) and tools and guidelines (n=19). Numerous initiatives incorporated multiple categories. The majority of initiatives were implemented by multidisciplinary teams and resulted in improved outcomes such as reduced length of stay and discharge delays. However, the experiences of patients and families were rarely reported. Included initiatives also lacked important contextual information, which is essential for replicating best practices and scaling up.ConclusionsThis scoping review identified a number of initiatives that have been implemented to target delayed discharges. While the majority of initiatives resulted in positive outcomes, delayed discharges remain an international problem. There are significant gaps and limitations in evidence and thus, future work is warranted to develop solutions that have a sustainable impact.

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Section: Resultsmentioning

confidence: 99%

Initiatives for improving delayed discharge from a hospital setting: a scoping review

et al. 2021

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“…Long-stay patients are often technology-dependent or need specialized care, and the lack of specific care units may delay PICU discharge, thereby resulting in an increase in resource consumption. In the last decades, a more efficient use of healthcare resources has been achieved by the development of home care programs, which help overcome the many barriers to the discharge of technology-dependent patients as mechanically ventilated patients 31 , 32 . Another factor that has contributed to reduce healthcare resource consumption is the creation of intermediate care units or technology-dependent care units 33 , 34 .…”

Section: Discussionmentioning

confidence: 99%

A comparative two-cohort study of pediatric patients with long term stay in ICUs

Mancebo

Navazo

Arteta

et al. 2021

Sci Rep

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During the last decades, the number of patients with long stay admissions (LSA) in PICU has increased. The purpose of this study was to identify factors associated with PICU LSA, assessing healthcare resources use and changes in the profile of these patients. A retrospective, observational, single-center study was carried out. Characteristics of LSA were compared between two periods (2006–2010 and 2011–2015). During the earlier period there were 2,118 admissions (3.9% of them LSA), whereas during the second period, there were 1,763 (5.4% of them LSA) (p = 0.025). LSA accounted for 33.7% PICU stay days during the first period and 46.7% during the second (p < 0.001). Higher use of non-invasive ventilation (80.2% vs. 37.8%, p = 0.001) and high-flow oxygen therapy (68.8% vs. 37.8%, p = 0.005) was observed in the 2011–2015 cohort, whereas the use of arterial catheter (77.1% vs. 92.6%, p = 0.005), continuous infusion of adrenaline (55.2% vs. 75.9%, p = 0.004), and hemoderivative transfusion (74% vs. 89.2%, p = 0.010) was less frequent. In the 2006–2010 cohort, hospital-acquired infections were more common (95.2% vs. 68.8%, p < 0.001) and mortality was higher (26.8% vs. 13.8%, p = 0.026). The number of long-stay PICU admissions have increased entailing an intensive use of healthcare resources. These patients have a high risk for complications and mortality.

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“…Furthermore, the exposure to stressors, and the disruption of parent-child interaction and sleep impact negatively on learning and developing. 12 Certainly, it is in the best interest of the child, family, and healthcare system overall to decrease inpatient hospitalization days and promote supported days at home where a child can access community and home-based programs that promote development. The issues of nursing shortages and skilled training of lay caregivers are as complex as the…”

Section: Discussionmentioning

confidence: 99%

Attributable Delay of Discharge for Children with Long-Term Mechanical Ventilation

Sobotka

Foster

Lynch

et al. 2019

The Journal of Pediatrics

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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 c 2 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%

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Prolonged Hospital Discharge for Children with Technology Dependency: A Source of Health Care Disparities

Cited by 19 publications

References 21 publications

Initiatives for improving delayed discharge from a hospital setting: a scoping review

Initiatives for improving delayed discharge from a hospital setting: a scoping review

A comparative two-cohort study of pediatric patients with long term stay in ICUs

Attributable Delay of Discharge for Children with Long-Term Mechanical Ventilation

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