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Innovative Discharge Process for Families with Pediatric Short Bowel Syndrome: A Prospective Nonrandomized Trial
Bram P Raphael1,2, Maria Jorina3, Mary Gallotto1,2
1Home Parenteral Nutrition Program, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
A hands-on training course for home parenteral nutrition (HPN) in children with short bowel syndrome (SBS) did not significantly reduce post-discharge complications or readmissions in this pilot study.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Surgical Outcomes
Background:
- Home parenteral nutrition (HPN) is crucial for children with short bowel syndrome (SBS) but often leads to complications.
- Effective predischarge training is essential to mitigate risks associated with HPN therapy.
Purpose of the Study:
- To evaluate a predischarge, hands-on HPN training course for pediatric SBS patients.
- To assess the impact of this training on reducing hospital readmissions and other post-discharge complications.
Main Methods:
- A prospective, nonrandomized controlled study involved children under 18 with SBS requiring HPN.
- An intervention group received 24-hour hands-on HPN training, while the control group received standard education.
- Data on post-discharge events were collected and compared between groups.
Main Results:
- Nine children were in the intervention group and 12 in the control group; all experienced at least one HPN-related issue (47 total).
- No significant difference in 30-day post-discharge events was found between the intervention and control groups.
- Increased length of stay was associated with higher odds of emergency department visits and readmissions.
Conclusions:
- The pilot hands-on HPN training intervention did not significantly decrease post-discharge complications in pediatric SBS patients.
- Further refinement of HPN discharge processes and the establishment of quality benchmarks are necessary.
- Additional research is needed to improve HPN management and patient outcomes.
Background:
Home parenteral nutrition (HPN) is a life-sustaining therapy for short bowel syndrome (SBS) and other severe digestive diseases, but complications are common. We evaluated a predischarge HPN hands-on training course to reduce complications in children with SBS, including hospital readmissions.
Methods:
We conducted a prospective, nonrandomized controlled research study between April 1, 2014, and April 30, 2017. Eligible participants were children aged <18 years old with SBS and anticipated HPN dependence duration ≥6 months. Excluded participants had a previous history of discharge with a central venous catheter (CVC), HPN, or intravenous fluids or strictly palliative goals of care. An intervention group practiced hands-on HPN within the hospital room for 24 hours using infusion equipment. The groups received standard teaching (CVC care, home infusion pump operation, HPN preparation and administration).
Results:
Nine children were assigned to the intervention group and 12 served as controls. The median age was 8.4 months, and length of stay (LOS) was 82 days. All participants experienced ≥1 event, with a total of 47 issues related to HPN. There were no significant associations between group assignment and 30-day postdischarge events. Each additional week of LOS was associated with 11% increase in the odds of an emergency department visit (OR 1.11; 95% CI, 1.01-1.26) and 16% increase in the odds of readmission (OR 1.16; 95% CI, 1.04-1.37).
Conclusions:
Postdischarge events remained widespread despite HPN bedside interventions offered by this pilot intervention. With refinement of HPN discharge processes, quality benchmarks are needed.
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