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Hospital to home transition of children with medical complexities in the Netherlands: current practice
H N Haspels1,2,3,4, H Knoester1,4, N J G Jansen4,5
1Department of Pediatric Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Insights
Discharging medically complex children home is often delayed by medical needs, parent training, and organizing home care. Many children are stable for discharge, indicating care reorganization opportunities.
Area of Science:
- Pediatric healthcare
- Complex care management
- Healthcare transitions
Background:
- Children with Medical Complexity (CMC) require intensive care, often prolonging hospital stays.
- Limited research exists on the reasons for delayed hospital-to-home (H2H) discharge in pediatric patients.
- Understanding these delays is crucial for improving H2H transitions.
Purpose of the Study:
- To describe the characteristics of CMC in the H2H transition phase.
- To identify the primary reasons for delayed H2H discharge in CMC.
- To inform strategies for optimizing pediatric H2H care transitions.
Main Methods:
- Prospective, multicenter, observational cohort study.
- Inclusion of 44 pediatric patients (0-18 years) in H2H transition across four Dutch University Medical Centers.
- Data collection on demographics, clinical course, and reasons for discharge postponement.
Main Results:
- The median hospital stay was 7.3 weeks, with 72.7% of participants under one year old.
- Discharge was postponed for 65.1% due to combined medical and organizational/family factors.
- Organizational/family factors alone delayed discharge for 34.9% of patients.
Conclusions:
- Delayed H2H discharge for CMC is influenced by medical needs, parent training duration, and home care organization challenges.
- A significant portion of CMC patients are medically stable, suggesting potential for care process improvements.
- Further research into transitional care programs is needed to enhance the H2H process for CMC.
Abstract:
Children with Medical Complexity (CMC) often require 24/7 expert care, which may impede discharge from hospital to home (H2H) resulting in prolonged admission. Limited research exists on pediatric patients with delayed discharges and the underlying reasons for such extended admissions. Therefore, our objectives were to (1) describe the demographics, clinical characteristics, and course of CMC who are in their H2H transition and (2) identify the reasons for postponement of H2H discharge. Prospective, multicenter, observational cohort study performed from February 2022 until November 2022 for 6 months in four Dutch University Medical Center children's hospitals. Clinically admitted patients (age 0-18 years) were eligible for inclusion if they were medically stable, yet required specialized nursing and/or paramedical care and were in the H2H transition process. In total, 44 participants were included, of whom 32 (72.7%) were younger than 1 year. Median stay in the hospital was 7.3 weeks (range 0.7-28.7). Upon entering the H2H phase, postponement of discharge was for 65.1% of the patients primarily due to a combination of medical reasons and organizational/family factors. For the remaining 34.9% of the patients, discharge was delayed solely due to organizational and/or family factors. CONCLUSION : Our study highlights several reasons contributing to the postponement of discharge for pediatric patients with medical complexity, including their medical fragility, the time-consuming process of parent training, and the challenges in organizing home care. Future steps should explore various transitional care programs aimed at improving the H2H transition. What is Known: • Hospital to home transition for Children with Medical Complexity is a multi-faceted process with many challenges and obstacles • Insight into the current practice of transitioning home in University Medical Centers remains unknown and is needed to develop a tailored yet standardized approach What is New: • Our findings reveal reasons for postponement of discharge home and show that patients are medically stable for more than half of their hospital stays. This indicates potential opportunities to reorganize care for better outcomes for the child, the family, and healthcare consumption.
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