Identification of Fail Points for Discharging Pediatric Patients With New Tracheostomy and Ventilator

Abstract

BACKGROUND AND OBJECTIVES: The core mission of the Pulmonary Habilitation Program is to train and prepare caregivers for the care of a ventilated child in the home. It exists within a free-standing children’s hospital. The program is supported by a multidisciplinary staff and serves ∼100 children. Through standardizing electronic documentation with process-specific tracking for the discharge process, the Pulmonary Habilitation Program team sought to identify intervention opportunities for more efficient and effective discharges. METHODS: The process of discharge was described using an iterative process, with the multidisciplinary team and discharge milestones noted in the medical chart. RESULTS: Several nonmedical factors contribute to prolonged hospital stays, including parent training, approval from the state agency for home care, and staffing of home nursing. Children had median lengths of stay of 141 days (interquartile range, 68 to 177). CONCLUSIONS: As a result of this initial investigation, application to the state agency and training for caregivers have been initiated sooner, when a tracheostomy is first placed.