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Published on: January 17, 2011
Low-Resource Hospital Days for Children Following New Tracheostomy
Cara A Cecil1, Adam C Dziorny2, Matt Hall3
1Ann and Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Insights
Low-resource days (LRDs) are common for children needing tracheostomy and mechanical ventilation. Younger age, early tracheostomy, Asian race, and longer hospital stays increase LRD risk, impacting transitional care resource utilization.
Area of Science:
- Pediatric critical care medicine
- Healthcare resource utilization
- Transitional care models
Background:
- Children requiring tracheostomy and invasive mechanical ventilation (IMV) need specialized transitional care.
- Understanding hospital resource use during this phase is crucial for optimizing patient care and operational efficiency.
Purpose of the Study:
- To define and characterize low-resource days (LRDs) in pediatric patients with new tracheostomy and IMV.
- To identify factors associated with the occurrence of LRDs in this population.
Main Methods:
- Retrospective cohort analysis of children (≤21 years) with new tracheostomy and IMV dependence (2017-2022).
- Utilized the Pediatric Health Information System database.
- Defined LRDs as post-tracheostomy days with non-room charges <10% of postoperative day 1 charges; analyzed factors using negative binomial regression.
Main Results:
- Among 4048 children, 38.6% experienced ≥1 LRD and 16.4% experienced ≥7 LRDs.
- Younger age at tracheostomy, Asian race, early tracheostomy, and longer post-tracheostomy hospitalizations were associated with increased LRDs.
- Median post-tracheostomy stay was 69 days.
Conclusions:
- Nearly 1 in 6 children experienced 7 or more LRDs, indicating a significant occurrence.
- Key factors associated with LRDs include younger age, early tracheostomy, Asian race, and prolonged hospital stays.
- Findings highlight the need to explore innovative care models for children with IMV dependence, focusing on the post-acute phase and bed utilization.
Background And Objectives:
Children with new tracheostomy and invasive mechanical ventilation (IMV) require transitional care involving caregiver education and nursing support. To better understand hospital resource use during this transition, our study aimed to: (1) define and characterize low-resource days (LRDs) for this population and (2) identify factors associated with LRD occurrence.
Methods:
This retrospective cohort analysis included children ≤21 years with new tracheostomy and IMV dependence admitted to an ICU from 2017 to 2022 using the Pediatric Health Information System database. A LRD was defined as a post tracheostomy day that accrued nonroom charges <10% of each patient's accrued nonroom charges on postoperative day 1. Factors associated with LRDs were analyzed using negative binomial regression.
Results:
Among 4048 children, median post tracheostomy stay was 69 days (interquartile range 34-127.5). LRDs were common: 38.6% and 16.4% experienced ≥1 and ≥7 LRDs, respectively. Younger age at tracheostomy (0-7 days rate ratio [RR] 2.42 [1.67-3.51]; 8-28 days RR 1.8 (1.2-2.69) versus 29-365 days; Asian race (RR 1.5 [1.04-2.16]); early tracheostomy (0-7 days RR 1.56 [1.2-2.04]), and longer post tracheostomy hospitalizations (31-60 days RR 1.85 [1.44-2.36]; 61-90 days RR 2.14 [1.58-2.91]; >90 days RR 2.21 [1.71-2.86]) were associated with more LRDs.
Conclusions:
Approximately 1 in 6 children experienced ≥7 LRDs. Younger age, early tracheostomy, Asian race, and longer hospital stays were associated with increased risk of LRDs. Understanding the postacute phase, including bed utilization, serves as an archetype to explore care models for children with IMV dependence.
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