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Length of Stay and Barriers to Discharge for Technology-Dependent Children During the COVID-19 Pandemic
Margaret Rush1,2, Amina Khan1,2, John Barber1
1Children's National Hospital, Washington, District of Columbia.
Insights
The COVID-19 pandemic prolonged hospital stays for technology-dependent children due to discharge barriers, particularly finding trained caregivers. Length of stay (LOS) increased by 32.2% during the early pandemic.
Area of Science:
- Pediatric healthcare research
- Public health and epidemiology
- Health services research
Background:
- Technology-dependent children face discharge challenges due to limited in-home services during pandemics.
- These transition difficulties can lead to increased length of stay (LOS).
Purpose of the Study:
- To evaluate changes in LOS for technology-dependent children.
- To describe discharge barriers for these children during the COVID-19 pandemic compared to prepandemic periods.
Main Methods:
- Retrospective chart review of technology-dependent children discharged between January 1 and May 28, 2020.
- Comparison of prepandemic and early pandemic discharge cohorts.
- Analysis of LOS and discharge barriers using multivariate regression and statistical tests.
Main Results:
- Discharge during the early pandemic was associated with a 32.2% longer LOS after adjustment.
- The frequency of discharge barriers remained high but did not change significantly between cohorts.
- A lack of trained caregivers became a more significant barrier during the pandemic (P = .03).
Conclusions:
- Frequent discharge barriers exist for technology-dependent children.
- The COVID-19 pandemic negatively impacted LOS, increasing it for this vulnerable population.
- Identifying trained caregivers emerged as a greater challenge during the pandemic.
Background And Objective:
During the coronavirus disease 2019 pandemic, technology-dependent children are at risk of encountering barriers to hospital discharge because of limits to in-home services. Transition difficulties could increase length of stay (LOS). With this study, we aim to (1) evaluate change in LOS and (2) describe barriers to hospital discharge between prepandemic and early pandemic periods for technology-dependent children.
Methods:
A retrospective chart review of technology-dependent children discharged from an acute and specialty pediatric hospital within a single urban area between January 1 and May 28, 2020 was conducted. Technology dependence was defined by using a validated complex chronic condition coding system. Patients discharged prepandemic and during the pandemic were compared. Outcomes included LOS and the number and type of discharge barriers (a factor not related to a medical condition that delays discharge). Multivariate regression modeling and parametric and nonparametric analysis were used to compare cohorts.
Results:
Prepandemic, 163 patients were discharged, and 119 were discharged during the early stages of the pandemic. The most common technology dependence was a feeding tube. The unadjusted median LOS was 7 days in both groups. After adjusting for patient-level factors, discharge during the pandemic resulted in a 32.2% longer LOS (confidence interval 2.1%-71.2%). The number of discharge barriers was high but unchanged between cohorts. Lack of a trained caregiver was more frequent during the pandemic (P = .03).
Conclusions:
Barriers to discharge were frequent for both cohorts. Discharge during the pandemic was associated with longer LOS. It was more difficult to identify a trained caregiver during the pandemic.
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