OBJECTIVE Children who require chronic mechanical ventilation via tracheostomy are medically complex and require prolonged hospitalization, placing a heavy burden on caregivers and hospital systems. We developed an interdisciplinary Ventilator Care Program to relieve this burden, through improved communication and standardized care. We hypothesized that a standardized team approach to the discharge of tracheostomy- and ventilator-dependent children would decrease length of stay (LOS), reduce patient costs, and improve safety. METHODS We used process mapping to standardize the discharge process for children requiring chronic ventilation. Interventions included developing education materials, a Chronic Ventilation Road Map for caregivers, utilization of the electronic medical record to track discharge readiness, team-based care coordination, and timely case management to arrange home nursing. We aimed to decrease overall and pediatric respiratory care unit LOS as the primary outcomes. We also analyzed secondary outcomes (mortality, emergency department visits, unplanned readmissions), and per-patient hospital costs during 2-year “preintervention” and “postintervention” periods (n = 18 and 30, respectively). RESULTS Patient demographics were not different between groups. As compared with the preintervention cohort, the overall LOS decreased 42% (P = .002). Pediatric respiratory care unit LOS decreased 56% (P = .001). As a result, unplanned readmissions, emergency department visits, and mortality were not increased. Direct costs per hospitalization were decreased by an average of 43% (P = .01). CONCLUSIONS Although LOS remained high, a standardized discharge process for chronically ventilated children by an interdisciplinary Ventilator Care Program team resulted in decreased LOS and costs without a negative impact on patient safety.

Simulation training can be incorporated into discharge training for families of children requiring LTMV. Rehearsal of emergency management in a simulated clinical setting increases caregiver confidence to assume care for their ventilator-dependent child.

saturation group. It is known that SGA infants have higher mortality and worse outcomes compared with AGA infants of the same gestation. 3 Furthermore, growth restriction has been shown to increase the risk of pulmonary hypertension in the setting of bronchopulmonary dysplasia. 4-6 These reports mirror our finding of bronchopulmonary dysplasia as a leading mortality cause in the SGA cohort. We view these analyses as hypothesis generating. These results must be confirmed in other oxygen targetting studies. An important opportunity to do this is in the planned Neonatal Oxygenation Prospective Meta-analysis, which includes data from 4800 infants with a prespecified analysis by growth status. We speculate that SGA infants may experience hypoxia in utero that destabilizes respiratory control or affects pulmonary vascular resistance, increasing vulnerability to lower saturation targets.

No abstract

Two incubation procedures were used for the determination, in vitro, of the steady-state Li+ ratio between red cells and external media. The Li+ ratio in vitro determined prior to Li+ therapy correlates significantly with the subsequent ratio in vivo between red cells and plasma in patients treated with Li+. The Li+ ratio determined in vitro in patients during Li+ therapy was significantly higher than the value determined during the pretreatment, drug-free period that correlated significantly with Li+ ratios in vivo. The in vitro procedure used thus could be applied in the prediction of the in vivo Li+ ratio, and possibly of the response to Li+, in patients before treatment is begun. It also could be used for studies on abnormalities and on the genetics of Li+ transport in affective illness.