Encounters From Device Complications Among Children With Medical Complexity

Abstract

A B S T R A C TOBJECTIVES: Children with medical complexity (CMC) are commonly assisted by medical devices to support essential body functions, although complications may lead to preventable emergency department (ED) and hospital use. Our objective was to identify predictors of device-complicated ED visits and hospitalizations.METHODS: This single-center retrospective cohort study included patients referred to a Pediatric Complex Care Program between April 1, 2014, and April 30, 2016, assisted by at least 1 medical device. Hospitalizations and ED visits in the year before enrollment were rated for likelihood for being due to device complications. Interrater reliability among 3 independent reviewers was assessed. Bivariate followed by multivariate logistic regression clustered by patient helped us identify associations between demographic, clinical, and device characteristics associated with device-complicated ED or hospital encounters. RESULTS:Interrater reliability was high (k 5 0.92). Among 98 CMC, device-complicated encounters represented 17% of 258 hospitalizations and 31% of 228 ED visits. Complications of 3 devices (central venous catheters, enteral tubes, and tracheostomy tubes) accounted for 13% of overall hospitalizations and 28% of overall ED visits. Central venous catheter presence (adjusted odds ratio [aOR] 3.2 [95% confidence interval (CI) 1.1-9.5]) was associated with device-complicated ED visits. Gastrojejunostomy/jejunostomy tube presence (aOR 3.3 [95% CI 1.5-7.5]) or tracheostomies with (aOR 8.1 [95% CI 2.3-28.5]) or without (aOR 4.5 [95% CI 1.7-7.5]) ventilator use was associated with device-complicated hospitalizations. Clinical variables were poor predictors of device-complicated encounters.CONCLUSIONS: Device-complicated ED visits and hospitalizations comprised a substantial proportion of total hospital and ED use. Developing interventions to prevent device complications may be a promising strategy to reduce overall CMC use.

Children with Medical Complexity: Challenges and Opportunities for Human Factors/Ergonomics

“…Most CMC require the use of medical devices, such as tracheostomies and enteral feeding, yet device complications are common and have been associated with frequent emergency department visits or hospitalizations (Berry et al, 2011;Nackers et al, 2019). Our research found that device complications account for 17% of overall hospitalizations and 30% of overall emergency department (ED) visits for children in our pediatric complex care program (Nackers et al, 2019).…”

Complex Care Program Enrollment and Change in ED and Hospital Visits from Medical Device Complications

“… 3 Device complications appear to comprise a sizable proportion of overall ED and hospital use for CMC, with one previous study suggesting as much as 17% of total hospitalizations for CMC with medical devices were due to device complications in the year before enrollment in a complex care program. 1 One of the only other studies to quantify the proportion of hospitalizations attributed to medical device complications observed that 9% of hospitalizations for CMC were due to medical device complications 2 ; however, those children were already enrolled in a complex care program.…”

“…Visits likely related to device complications were identified using a method previously described. 1 Three reviewers (a trained research assistant and two physician reviewers, each with over 10 years of complex care experience) established high interrater reliability (Kappa = 0.92).…”

“…Complications related to these devices, such as tracheostomy tube dislodgement or central venous catheter infections, often lead to emergency department (ED) visits and hospitalizations. 1 , 2 Medical device complications are among the most common reasons for hospital admission among CMC, 2 – 4 and many of these encounters may be preventable. 3 …”

Codesign and Usability Testing of a Mobile Application to Support Family-Delivered Enteral Tube Care

“…11 As such, enteral tube complications can make up a sizable proportion of overall ED and hospital use experienced by CMC. 2,12 Mobile health (mHealth) and mobile applications (apps) have the potential to support CMC enteral tube care, prevent complications, and improve child and family outcomes by serving as a portable resource and organizational tool to improve collaborative symptom tracking, monitoring, and management of chronic conditions and improve caregiver communication. [13][14][15] Although apps to support caregiving exist, most are designed to support patients with less complex conditions (eg, asthma, diabetes), and their impact on health outcomes is poorly understood.…”