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Home Health Care Availability and Discharge Delays in Children With Medical Complexity
Roy Maynard1,2, Eric Christensen3, Rhonda Cady4
1Children's Minnesota, Minneapolis, Minnesota; rcmaynard@pediatrichomeservice.com.
Insights
A shortage of pediatric home care nurses significantly increases hospital stays for technology-dependent children. This lack of nursing care is the primary driver of delayed discharges and associated costs for these vulnerable patients.
Area of Science:
- Pediatric Healthcare
- Healthcare Management
- Nursing Shortage Impact
Background:
- Technology-dependent children represent a growing proportion of pediatric hospital days.
- The impact of home care nursing (HCN) shortages on length of stay and readmissions for these children is not well-documented.
Purpose of the Study:
- To investigate the impact of pediatric home care nursing shortages on delayed discharges and readmissions.
- To identify causes and quantify the effect of delayed discharge on length of stay in technology-dependent children.
Main Methods:
- A 12-month prospective, multisite study of children with medical complexity discharging to home health.
- Two cohorts were studied: new patients and existing patients transitioning to home nursing.
- A modified delay tool was used to categorize causes of delayed discharge (DD) and unplanned 90-day readmissions.
Main Results:
- Delayed discharge (DD) occurred in 68.5% of new patients and 9.2% of existing patients.
- Lack of HCN was the primary cause of DD, increasing length of stay by an average of 53.9 days for new patients and 35.7 days for existing patients.
- Unplanned 90-day readmissions were mainly due to medical setbacks (96.7%), affecting 53.7% of new and 45.0% of existing patients.
Conclusions:
- Delayed discharge and associated costs are largely driven by HCN shortages, particularly impacting new patients.
- Medical setbacks are the leading cause of unplanned 90-day readmissions.
- Increasing HCN availability or postacute care facilities could reduce prolonged hospital stays.
Abstract:
: media-1vid110.1542/5849572914001PEDS-VA_2018-1951Video Abstract BACKGROUND: An increasing proportion of pediatric hospital days are attributed to technology-dependent 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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