Discharge Practice Variability in Pediatric Chronic Home Invasive Ventilation

Area of Science:

• Pediatric Pulmonology
• Respiratory Care
• Healthcare Quality Improvement

Background:

• Pediatric chronic home invasive ventilation (PCHIV) is managed by a multidisciplinary team.
• Discharge practices for PCHIV are not always led by pediatric pulmonologists.
• Variability in discharge practices may impact adherence to established guidelines.

Purpose of the Study:

• To assess adherence to American Thoracic Society (ATS) guidelines for PCHIV.
• To investigate variability in PCHIV discharge practices across different centers and teams.
• To identify differences in adherence based on discharging teams (pulmonary vs. ICU).

Main Methods:

• A survey was distributed to pediatric pulmonologists regarding PCHIV discharge practices.
• Adherence to six key ATS recommendations for PCHIV was assessed.
• Respondents were categorized into 'pulmonary' (non-ICU discharge) and 'ICU' (ICU discharge) groups.

Main Results:

• Lowest adherence was observed for ongoing caregiver education and standardized discharge criteria.
• The requirement for two caregivers was frequently waived.
• Significant differences were found in annual discharge numbers, caregiver training duration, and use of standardized discharge criteria between pulmonary and ICU groups.

Conclusions:

• Adherence to ATS PCHIV guidelines is variable across institutions and discharging teams.
• A notable number of PCHIV patients are discharged from ICUs by non-pulmonology teams.
• Addressing barriers to guideline implementation and fostering collaboration are crucial for optimizing PCHIV care.