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 journalArticle

3 Citations (Scopus)

Abstract

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
JournalPediatrics
Volume143
Issue number1
DOIs
StatePublished - Jan 1 2019

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Home Nursing
Home Care Services
Delivery of Health Care
Length of Stay
Subacute Care
Costs and Cost Analysis
Patient Readmission
Community Health Nurses
Pediatric Hospitals
Tracheostomy
Prospective Studies
Pediatrics
Health

PubMed: MeSH publication types

  • Journal Article

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Maynard, R., Christensen, E., Cady, R., Jacob, A., Ouellette, Y., Podgorski, H. A., ... Wheeler, W. (2019). Home health care availability and discharge delays in children with medical complexity. Pediatrics, 143(1), [e20181951]. https://doi.org/10.1542/peds.2018-1951

Home health care availability and discharge delays in children with medical complexity. / Maynard, Roy; Christensen, Eric; Cady, Rhonda; Jacob, Abraham; Ouellette, Yves; Podgorski, Heather A; Schiltz, Brenda; Schwantes, Scott; Wheeler, William.

In: Pediatrics, Vol. 143, No. 1, e20181951, 01.01.2019.

Research output: Contribution to journalArticle

Maynard, R, Christensen, E, Cady, R, Jacob, A, Ouellette, Y, Podgorski, HA, Schiltz, B, Schwantes, S & Wheeler, W 2019, 'Home health care availability and discharge delays in children with medical complexity', Pediatrics, vol. 143, no. 1, e20181951. https://doi.org/10.1542/peds.2018-1951
Maynard, Roy ; Christensen, Eric ; Cady, Rhonda ; Jacob, Abraham ; Ouellette, Yves ; Podgorski, Heather A ; Schiltz, Brenda ; Schwantes, Scott ; Wheeler, William. / Home health care availability and discharge delays in children with medical complexity. In: Pediatrics. 2019 ; Vol. 143, No. 1.
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abstract = "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.",
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