Attributable Delay of Discharge for Children with Long-Term Mechanical Ventilation
Attributable Delay of Discharge for Children with Long-Term Mechanical Ventilation
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DOI：
10.1016/j.jpeds.2019.04.034
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发表时间：
2019-09-01
影响因子：
5.1
通讯作者：
Goodman, Denise M.
中科院分区：
文献类型：
--
作者：
Sobotka, Sarah A.;Foster, Carolyn;Goodman, Denise M.
目的探讨长期机械通气患儿延迟出院的原因。对芝加哥Lurie儿童医院的人口统计学信息、医疗诊断、医疗稳定性、出院回家、延迟出院的原因和家庭护理时间进行回顾性分析。所有患者均在机械通气下出院。出院延迟定义为医学稳定后>10天。分析了医院收费，并从延误之日起对超额收费进行了量化。结果在72例患者中，55%为男性，平均年龄1.8岁（SD 3.8），在气管切开术放置的护理时间和人口统计学进行了比较的描述性统计和皮尔逊卡（2）检验。最常见的长期机械通气适应症是慢性肺病（n = 47，65%）; 54%的患者出院延迟，大多数主要是由于缺乏家庭护理（62%），其次是护理人员培训延迟（18%）、护理人员健康和社会问题（8%）以及过渡护理机构床位延迟（8%）。在39名延迟的患者中，10%（13217889美元）的住院费用发生在超额天数，中位数为186061美元（IQR $117 661-$386 905）每例患者。结论超过一半的儿童出院到社区从一个大型住院儿童长期机械通气计划有一个非医疗延迟出院回家，最常见的原因是家庭护士的配备。该病例系列提供了进一步的证据，证明家庭护理的有限性阻碍了有效的出院和重新住院。
Objective To assess the reasons for discharge delays for children with long-term mechanical ventilation.Study design Charts of children (0-18 years of age) with a new tracheostomy in the Pulmonary Habilitation Program at the Ann and Robert H. Lurie Children's Hospital of Chicago were retrospectively reviewed for demographic information, medical diagnoses, medical stability, discharge to home, reasons for discharge delay, and hours of staffed home nursing. All patients were discharged on mechanical ventilation. Discharge delay was defined as >10 days after medical stability. Hospital charges were analyzed and excess charges quantified beginning with the date of delay. Descriptive statistics and Pearson chi(2) tests were used to compare nursing hours and demographics.Results Of 72 patients, 55% were male with mean age 1.8 years (SD 3.8) at tracheostomy placement. The most common long-term mechanical ventilation indication was chronic lung disease (n = 47, 65%); 54% had discharge delays, the majority were primarily due to lack of home nursing (62%), followed by delay of caregiver training (18%), caregiver health and social issues (8%), and delay in a transitional care facility bed (8%). Of the 39 delayed patients, 10% ($13 217 889) of hospital charges occurred during excess days with a median of $186 061 (IQR $117 661-$386 905) per patient.Conclusions Over one-half of children discharged to the community from a large inpatient pediatric long-term mechanical ventilation program had a nonmedical delay of discharge home, most commonly because of home nurse staffing. This case series provides further evidence that limited availability of home nursing impedes efficient discharge and prolongs hospitalizations.