The final hospital need in children discharged from a cardiology acute care unit: a single-centre survey study

Abstract

Objective: Children with heart disease may require inpatient care for many reasons, but ultimately have a final reason for hospitalisation prior to discharge. Factors influencing length of stay in paediatric cardiac acute care units have been described but the last reason for hospitalisation has not been studied. Our aim was to describe Final Hospital Need as a novel measure, determine Final Hospital Need in our patients, and describe factors associated with this Need. Methods: Single-centre survey design. Discharging providers selected a Final Hospital Need from the following categories: cardiovascular, respiratory, feeding/fluid, haematology/ID, pain/sedation, systems issues, and other/wound issues. Univariable and multivariable analyses were performed separately for outcomes “cardiovascular” and “feeding/fluid.” Measurements and Results: Survey response rate was 99% (624 encounters). The most frequent Final Hospital Needs were cardiovascular (36%), feeding/fluid (24%) and systems issues (13%). Probability of Final Hospital Need “cardiovascular” decreased as length of stay increased. Multivariate analysis showed Final Hospital Need “cardiovascular” was negatively associated with aortic arch repair, Norwood procedure, and Final ICU Need “respiratory” and “other.” Final Hospital Need "feeding/fluid” was negatively associated with left-sided valve procedure, but positively associated with final ICU need “respiratory,” and tube feeding at discharge. Conclusions: Final Hospital Need is a novel measure that can be predicted by clinical factors including age, Final ICU Need, and type of surgery. Final Hospital Need may be utilised to track changes in clinical care over time and as a target for improvement work.