Obstacles to Discharge of Ventilator-Assisted Children From the Hospital to Home

DeWitt, Pamela; Jansen, Mary T.; Ward, Sally L. Davidson; Keens, Thomas G.

doi:10.1378/chest.103.5.1560

Cited by 47 publications

(60 citation statements)

References 15 publications

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“…Para a adequada seleção do paciente deve-se ter em mente todas estas indicações e contra-indicações a fim de que, evidentemente, os objetivos possam ser atingidos [9][10][11] .…”

Section: Discussionunclassified

Assistência ventilatória domiciliar em crianças: descrição de um programa

Resener¹,

Martinez

Reiter³

et al. 2001

J. Pediatr. (Rio J.)

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ResumoObjetivo: o número de pacientes pediátricos dependentes de suporte ventilatório vem aumentando de maneira relevante nas últimas décadas. Essas crianças permanecem por longos períodos internadas, freqüentemente em unidades de terapia intensiva. Para minimizar as hospitalizações, tem sido dada ênfase à continuação da terapia ventilatória no domicílio. No presente trabalho descreve-se um programa de assistência ventilatória domiciliar desenvolvido na Alemanha, visando antever a possibilidade de adaptação à nossa realidade. Conclusion: the program relies on a permanent multidisciplinary staff to treat intercurrent diseases. Patients, at predetermined periods, are re-evaluated as to the evolution of respiratory insufficiency. The adequate system organization provides patients and their families with security, and accounts for the success of the home ventilatory support program. A great deal of organizational efforts should be consolidated before implementing similar programs in Brazil.J Pediatr (Rio J) 2001; 77 (2): 84-8: artificial respiration, respiratory insufficiency, lung diseases.

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“…Para a adequada seleção do paciente deve-se ter em mente todas estas indicações e contra-indicações a fim de que, evidentemente, os objetivos possam ser atingidos [9][10][11] .…”

Section: Discussionunclassified

Assistência ventilatória domiciliar em crianças: descrição de um programa

Resener¹,

Martinez

Reiter³

et al. 2001

J. Pediatr. (Rio J.)

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“…A study of ventilator-assiste d children conducted between 1977-1991 indicated that the greatest obstacle to hospital discharge after children were medically stable was lack of home care funding. The waiting time for funding was more than three months on the average (Dewitt et al, 1993). The total length of stay and time to arrange home care funding was significantly longer for children funded by public agencies than for those covered by private insurance.…”

Section: Societal Factorsmentioning

confidence: 99%

“…In the literature, factors that influence extended hospital stay for children dependent on technology are divided into three groups: health care factors (Millner, 1991;Dewitt, Jansen, Davidson-Ward, & Keens, 1993;Steele & Sterling, 1992;Wong, 1991), societal factors (Millner, 1991;Dewitt et al, 1993;Schor, 1988;Caring Institute, 1987), and parental factors (Millner, 1991;Canam, 1993;OTA, 1987;Schor, 1988).…”

Section: Background Literaturementioning

confidence: 99%

“…Finally, there must be adequate community support available to meet the needs of the child and his or her family (Caring, 1987). While Millner (1991) found that children dependent on technology often remained hospitalized because of a shortage of skilled home nursing services, Dewitt et al (1993) found the availability of nurses or home care vendors was not an obstacle to hospital discharge.…”

Section: Health Care Factorsmentioning

confidence: 99%

“…The HMOs also placed limits on the amount and duration of mental health, ancillary services, and other services frequently needed by chronically ill children, including the choice of specialty providers (Fox et al, 1993). Dewitt et al (1993) attributed the reason for the average one year of additional hospitalization in their population to the difficulty in locating medical foster care for ventilator-assisted children. Millner (1991) identified the lack of discharge options including a shortage of beds in skilled nursing facilities as contributing to prolonged hospitalization.…”

Section: Societal Factorsmentioning

confidence: 99%

See 2 more Smart Citations

Extended Hospitalization of Medically Stable Children Dependent on Technology: A Focus on Mutable Family Factors

Cross

Leonard

Skay

et al. 1998

Issues in Comprehensive Pediatric Nursing

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This study identified three factors that influenced extended hospital stay in medically stable children dependent on medical technology. A retrospective review of 50 charts in a level II nursery was conducted. Bivariate analysis identified factors contributing to extended stay: parental factors, societal factors, health care factors, and presence of disease. Multiple regression explained 98% of the variance in extended length of stay. Family factors accounted for 19.6%, nonfamily factors accounted for 42.5%, and the two sets of factors together accounted for an additional 35.9%. Family-related issues with a high potential for change were identified. Pediatric providers should develop family intervention strategies that identify the most appropriate level of care that both advocates in the best interest of the child and family and contains the rising cost of health care.

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Epidemiologic survey of 196 patients with congenital central hypoventilation syndrome

Vanderlaan

Holbrook

Wang

et al. 2004

Pediatric Pulmonology

151

139

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This study examined the cross-sectional medical and social characteristics of children diagnosed with congenital central hypoventilation syndrome (CCHS). A detailed questionnaire was mailed to all families with a child with CCHS who are affiliated with a family network or support group. The questionnaire response rate was >75% (n=196). Mean age was 10.22 years +/- 6.6 years (SD) (range, 0.4-38 years), with a 1:1 sex ratio. Multisystem involvement was almost universal among the cohort, with Hirschsprung's disease (HD) present in 16.3%; 61.7% of the children had a tracheotomy, but 14.3% were never tracheotomized, with 77 subjects (39.3%) not having a tracheostomy tube at time of survey. Respiratory support approaches varied but clearly reflected the trend towards earlier and more widespread transition to noninvasive ventilatory modalities. Significant developmental problems were noted, but attendance in regular classes occurred in the majority. Significant deficiencies in routine periodic evaluation and management were reported. In addition, the presence of CCHS was associated with a significant financial and psychosocial burden to the families. In conclusion, a comprehensive survey of 196 CCHS children and their families revealed a cross-sectional picture of substantial medical and psychosocial complexities associated with this disorder, and pointed out substantial inadequacies in routine preventive care that appear to impose stress on the families. The emerging trend of earlier transition to noninvasive ventilatory support warrants future studies. Implementation of recommended guidelines for diagnosis and multidisciplinary follow-up of CCHS should ultimately ameliorate the long-term outcome of this lifelong condition.

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Obstacles to Discharge of Ventilator-Assisted Children From the Hospital to Home

Cited by 47 publications

References 15 publications

Assistência ventilatória domiciliar em crianças: descrição de um programa

Assistência ventilatória domiciliar em crianças: descrição de um programa

Extended Hospitalization of Medically Stable Children Dependent on Technology: A Focus on Mutable Family Factors

Epidemiologic survey of 196 patients with congenital central hypoventilation syndrome

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