A Framework of Pediatric Hospital Discharge Care Informed by Legislation, Research, and Practice

Abstract

No widely used pediatric standards for hospital discharge care exist, despite nearly 10,000 pediatric discharges per day in the U.S. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality improvement efforts, and adversely affects the health and wellbeing of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal law within the Social Security Act that outlines standards for hospital discharge, a variety of toolkits aimed to improve discharge care, and the research evidence that supports the discharge process. We then outline a framework within which to organize the diverse activities that constitute discharge care to be executed throughout the hospitalization of a child from admission to the actual discharge. In the framework, we describe processes to 1) initiate pediatric discharge care, 2) develop discharge care plans, 3) monitor discharge progress, and 4) finalize discharge. We contextualize these processes with a clinical case of a child undergoing hospital discharge. Use of this narrative review will help pediatric healthcare providers move forward to better understand what works and what does not during hospital discharge for children, while steadily improving their quality of care and health outcomes.

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children

“…Future studies should establish standardized frameworks and measures for evaluating discharge care quality. 47,48 The limitations of this collaborative are consistent with other initiatives to improve care across multiple sites. 49,50 First, the participating sites were all tertiary-care freestanding children's hospitals, so the results may not be generalizable to community hospitals or pediatric care provided in general hospitals.…”

Socioeconomic status influences the toll paediatric hospitalisations take on families: a qualitative study

“…This may require changes in how family-level risk is assessed, ancillary staff (eg, home health nurses, social workers) are trained and postdischarge interventions are deployed 44. For example, if families have limited access to follow-up medical care or prescriptions, alternative means of resource provision could be considered (eg, home visitation, phone follow-up, transportation assistance and/or medication delivery) 25 29 30. That being said, a common refrain across nearly all participants, regardless of SES, was the desire to balance the potential benefit of supports aimed at lingering stress with the hope to quickly return to normalcy.…”

Comorbidities and Complications of Spinal Fusion for Scoliosis

“…For example, it might be effective to plot and implement instructions and action plans to avoid entirely or mitigate the severity of a variety of acute illnesses that resulted in hospital readmission in the current study, including respiratory infections, gastrointestinal dysmotility, kidney/urinary tract infections, and seizures. 41 Additional attention to the involvement and ability of postdischarge clinicians, including primary, rehabilitation, and home care providers, to assist the children with their recovery and health optimization after acutecare discharge may be warranted. 42 Future efforts to standardize this planning into discharge care might have an effect on reducing unnecessary hospital readmissions after spinal fusion in CMC.…”