Home health care availability and discharge delays in children with medical complexity

Roy Maynard, Eric Christensen, Rhonda Cady, Abraham Jacob, Yves Ouellette, Heather A Podgorski, Brenda Schiltz, Scott Schwantes, William Wheeler

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


BACKGROUND: An increasing proportion of pediatric hospital days are attributed to technologydependent children. The impact that a pediatric home care nursing (HCN) shortage has on increasing length of hospital stay and readmissions in this population is not well documented. METHODS: We conducted a 12-month multisite prospective study of children with medical complexity discharging with home health. We studied the following 2 cohorts: new patients discharging for the first time to home nursing and existing patients discharging from the hospital to previously established home nursing. A modified delay tool was used to categorize causes, delayed discharge (DD) days, and unplanned 90-day readmissions. RESULTS: DD occurred in 68.5% of 54 new patients and 9.2% of 131 existing patients. Lack of HCN was the most frequent cause of DD, increasing costs and directly accounting for an average length of stay increase of 53.9 days (range: 4-204) and 35.7 days (3-63) for new and existing patients, respectively. Of 1582 DDs, 1454 (91.9%) were directly attributed to lack of HCN availability. DD was associated with younger age and tracheostomy. Unplanned 90-day readmissions were due to medical setbacks (96.7% of cases) and occurred in 53.7% and 45.0% of new and existing patients, respectively. CONCLUSIONS: DD and related costs are primarily associated with shortage of HCN and predominantly affect patients new to HCN. Medical setbacks are the most common causes of unplanned 90-day readmissions. Increasing the availability of home care nurses or postacute care facilities could reduce costly hospital length of stay.

Original languageEnglish (US)
Article numbere20181951
Issue number1
StatePublished - Jan 2019

Bibliographical note

Publisher Copyright:
Copyright © 2019 by the American Academy of Pediatrics.


  • Child
  • Critical Illness/therapy
  • Female
  • Follow-Up Studies
  • Health Services Accessibility/organization & administration
  • Home Care Services/organization & administration
  • Humans
  • Length of Stay/trends
  • Male
  • Patient Discharge/trends
  • Patient Readmission
  • Prospective Studies
  • Retrospective Studies
  • Time Factors
  • United States

PubMed: MeSH publication types

  • Video-Audio Media
  • Multicenter Study
  • Journal Article


Dive into the research topics of 'Home health care availability and discharge delays in children with medical complexity'. Together they form a unique fingerprint.

Cite this