A Standardized Discharge Process Decreases Length of Stay for Ventilator-Dependent Children

Area of Science:

• Pediatric critical care medicine
• Healthcare systems engineering
• Respiratory therapy

Background:

• Children requiring chronic mechanical ventilation via tracheostomy present complex medical needs, leading to prolonged hospitalizations.
• This prolonged care places a significant burden on families and healthcare systems.
• Existing care models often lack standardization, contributing to inefficiencies.

Purpose of the Study:

• To evaluate the impact of an interdisciplinary Ventilator Care Program on children dependent on mechanical ventilation.
• To test the hypothesis that a standardized team approach to discharge reduces length of stay (LOS), patient costs, and improves safety.
• To relieve the burden on caregivers and hospital systems through improved communication and standardized care.

Main Methods:

• Process mapping was used to standardize the discharge process for ventilator-dependent children.
• Interventions included developing educational materials, a caregiver roadmap, electronic health record utilization for discharge readiness tracking, team-based care coordination, and timely case management for home nursing arrangements.
• A comparative analysis was conducted between preintervention (n=18) and postintervention (n=30) cohorts over two years, analyzing overall and pediatric respiratory care unit LOS, mortality, emergency department visits, unplanned readmissions, and per-patient hospital costs.

Main Results:

• The overall length of stay (LOS) decreased by 42% (P = .002) and pediatric respiratory care unit LOS decreased by 56% (P = .001) in the postintervention cohort.
• Patient demographics were similar between the pre- and postintervention groups.
• Direct costs per hospitalization decreased by an average of 43% (P = .01), with no increase in mortality, emergency department visits, or unplanned readmissions.

Conclusions:

• A standardized discharge process implemented by an interdisciplinary Ventilator Care Program team significantly decreased LOS and associated costs for chronically ventilated children.
• The implemented program demonstrated no negative impact on patient safety outcomes.
• While LOS remains high, the standardized approach offers a viable strategy for improving efficiency and reducing financial burden in managing this complex pediatric population.