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Discharge of respiratory-compromised children after respiratory rehabilitation
Michal Katz Leurer1, Eliezer Be'eri, Dorit Zilbershtein
1Respiratory Rehabilitation Unit, Alyn Hospital, Jerusalem, Israel.
Insights
Discharging children requiring respiratory support home is challenging. Factors like family situation and continued mechanical ventilation predict longer or failed discharges, highlighting the need for better support.
Area of Science:
- Pediatric Respiratory Medicine
- Rehabilitation Sciences
- Healthcare Management
Background:
- Increasing demand for pediatric respiratory rehabilitation services.
- Challenges in discharging children dependent on tracheostomy and/or chronic mechanical ventilation home.
Purpose of the Study:
- Define rehabilitation and discharge timelines for these children.
- Identify predictors of prolonged or failed discharge processes.
Main Methods:
- Retrospective chart review of patients in a Respiratory Rehabilitation Unit.
- Analysis of 48 patients over a 4-year period.
Main Results:
- 31 patients discharged, 13 remained hospitalized, 4 died.
- Median hospitalization: 10 months (6 for rehab, 4 for discharge logistics).
- Predictors of prolonged discharge: unemployed father, disabled family member, ongoing mechanical ventilation.
Conclusions:
- Pediatric respiratory hospitalization can be prolonged due to medical and non-medical factors.
- Discharge is particularly difficult for specific patient subsets.
- Proactive policies, community support, and legislation are needed for efficient discharge.
Background:
There is a growing demand for respiratory rehabilitation services for children dependent on tracheostomy and/or chronic mechanical ventilation. Discharging these patients home following their rehabilitation can be an arduous process.
Objectives:
To define the length of time required to rehabilitate and discharge these patients, and to identify predictors of a prolonged or failed discharge process.
Methods:
We conducted a retrospective chart review of patients admitted to the Respiratory Rehabilitation Unit at Alyn Hospital, Jerusalem, over a 4 year period.
Results:
Of the 48 patients identified, 31 (64.7%) were eventually discharged, 13 (27.1%) remained hospitalized long-term, and 4 (8.3%) died during their hospitalization. The median length of hospitalization was 10 months: 6 months for purposes of rehabilitation therapy, and 4 months thereafter to resolve the logistics of discharge. Specific family characteristics--an unemployed father (odds ratio = 4.6, P = 0.02) and an additional family member with a disability (OR = 5.8, P = 0.03)--as well as ongoing mechanical ventilation at the time of discharge (OR = 5.5, P < 0.01) were found to positively correlate with a prolonged or failed discharge process.
Conclusions:
Hospitalization in a pediatric respiratory rehabilitation unit may be prolonged for both medical and non-medical reasons, with the process of discharge home being particularly difficult in certain subsets of patients. A proactive discharge policy by hospitals, improved community support services, and legislation defining the rights of home-ventilated children may facilitate more efficient discharge home of these patients.
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