Identification of Fail Points for Discharging Pediatric Patients With New Tracheostomy and Ventilator

Sobotka, Sarah A.; Hird‐McCorry, Lindsey P.; Goodman, Denise M.

doi:10.1542/hpeds.2015-0277

Cited by 32 publications

(44 citation statements)

References 10 publications

(11 reference statements)

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“…Through an initial investigation of the discharge process of pediatric patients with ventilators and tracheostomies in the Pulmonary Habilitation Program, Sobotka and colleagues have shown that approval of public funding and staffing of home nursing present two major barriers to the discharge process. 30 Collaboration among state agencies, nursing agencies, and hospital teams and the use of transitional care facilities may present opportunities for streamlining the discharge process and ultimately reducing readmissions. Creating comprehensive medical homes for medically complex children as well as integrated outpatient programs for children with tracheostomy may provide access to care outside of the hospital and reduce readmissions by providing regular follow-up care.…”

Section: Discussionmentioning

confidence: 99%

“…Creating comprehensive medical homes for medically complex children as well as integrated outpatient programs for children with tracheostomy may provide access to care outside of the hospital and reduce readmissions by providing regular follow-up care. 30 Future studies should investigate discharge procedures and follow-up care received by patients to investigate variations in patient and parent education on topics that could contribute to increased readmissions due to infections. Finally, our data may be used to risk stratify patients that may benefit from targeted intervention or improved care coordination to minimize readmission risk.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with 30-day all-cause hospital readmission after tracheotomy in pediatric patients

Mamey

Russell

2017

International Journal of Pediatric Otorhinolaryngology

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Objective To determine factors associated with post-tracheotomy hospital readmission within 30 days of discharge. Methods Children 18 years and younger who underwent tracheotomy at Children’s Hospital Los Angeles (CHLA) between 1/1/2005 and 12/31/2013 with at least 30 days of follow-up at CHLA were identified through ICD-9 procedure codes. Patient characteristics and covariates were obtained by linking manual chart review and administrative data. We used multivariate logistic regression to identify the independent association between risk factors and the primary outcome of 30-day all-cause same-hospital readmission. Results Of the 273 patients included, the median age at admission was 6 months [interquartile range (IQR): 1–51 months]. Among this primarily male (60.8%) and Hispanic (66.3%) cohort with a high proportion of discharge on positive pressure ventilation (47.1%), the 30-day readmission rate was 22% (n=60). Of the readmissions, 92% (n=55) were unplanned and 64% (n=35) were associated with acute respiratory illnesses. Multivariate regression analysis demonstrated that, among patients ≤ 12 months, discharge on positive pressure ventilation [adjusted odds ratio (aOR)=2.88, 95% confidence interval (CI)=1.19–6.97] was associated with increased odds of readmission, while gastrostomy tube placement during the tracheotomy hospitalization (aOR=0.42, 95% CI=0.19–0.96) and prematurity (aOR=0.35, 95% CI=0.15–0.83) were associated with decreased odds of readmission. In patients > 1 year of age, increased length of hospitalization (aOR=1.01 per hospital day, 95% CI=1–1.02) and presence of comorbid malignancy (aOR=6.03, 95% CI=1.25–29.16) were associated with increased odds of readmission. Conclusions Over one-fifth of children undergoing tracheotomy had an unplanned hospital readmission within 30 days after discharge. Because the majority of readmissions were unplanned and due to acute respiratory illnesses, future research should investigate how discharge procedures and improved care coordination may lower readmission rates in high-risk patients (e.g., patients discharged on positive pressure ventilation).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors associated with 30-day all-cause hospital readmission after tracheotomy in pediatric patients

Mamey

Russell

2017

International Journal of Pediatric Otorhinolaryngology

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“…In addition, reimbursement rates must support ongoing education of home nursing staff in areas of safety and technology . An added benefit to higher overall reimbursement rates and the availability of highly competent home care staff is the potential reduction in inpatient hospital days …”

Section: Discussionmentioning

confidence: 99%

“…24 An added benefit to higher overall reimbursement rates and the availability of highly competent home care staff is the potential reduction in inpatient hospital days. 25 There are many variables which affect the results of this study. In any pre/posttest design there is the possibility of participants "learning" the test and cuing into information which results in significant improvements in post test score.…”

Section: Factors Predicting Higher Scoresmentioning

confidence: 99%

Emergency airway and ventilator procedures for community based home care staff validation of an educational program

Ramsey

Brennan

Stricker

et al. 2018

Pediatric Pulmonology

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“…When hospitalized, children with HMV assistance present with multiple comorbidities which require complex tertiary care . They have long hospitalizations, frequent readmissions, multiple providers involved in their care, high inpatient resource utilization, and challenging care coordination demands . Examples of outpatient needs include private duty nursing, durable medical equipment, primary care and subspecialty appointment coordination, and therapy and special education services.…”

Section: Introductionmentioning

confidence: 99%

Pediatric patients with home mechanical ventilation: The health services landscape

Sobotka

Gaur

Goodman

et al. 2018

Pediatric Pulmonology

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Objective Children with invasive home mechanical ventilation (HMV) are a growing population with complex health service needs. Single institution studies provide insight into successful program structures and outcomes. Our study objectives were to assess health service structures, providers, and programs caring for this population throughout the U.S., and to understand barriers to high‐quality care. Design Using purposeful sampling with capture‐recapture and snowball sampling methods, we identified key informants for care of the U.S. pediatric HMV population. Informants received web‐based surveys with two reminders. Survey domains included respondent characteristics, HMV team composition, and barriers to care. Results Survey response was 71% with 101 completed. Respondents caring for patients in 45 states included physicians (61%), nurses (20%), therapists (12%), case managers (4%), and social workers (2%). Half (53%) of physicians were fellowship trained, most commonly pulmonology (22%) and critical care medicine (13%). The majority (65%) of providers described a dedicated HMV service. The majority (61%) of respondents from a HMV service provided both inpatient and outpatient care. Nearly all respondents (96%) described an inadequate supply of home nurses and 88% reported inadequate respite facilities. Conclusions Children with HMV assistance receive care from a diverse group of providers with varied team structure. Heterogeneity may reflect patient diversity and provider interest, increasing efficacy but challenging standardization nationwide. Despite team structure variability, similar home care difficulties were universally experienced. Data suggest that the home nursing shortage is a national impediment to quality and efficient discharge with limited community‐based support for this vulnerable population.

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Identification of Fail Points for Discharging Pediatric Patients With New Tracheostomy and Ventilator

Abstract: As a result of this initial investigation, application to the state agency and training for caregivers have been initiated sooner, when a tracheostomy is first placed.

Cited by 32 publications

References 10 publications

Factors associated with 30-day all-cause hospital readmission after tracheotomy in pediatric patients

Factors associated with 30-day all-cause hospital readmission after tracheotomy in pediatric patients

Emergency airway and ventilator procedures for community based home care staff validation of an educational program

Pediatric patients with home mechanical ventilation: The health services landscape

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