Length of Stay and Barriers to Discharge for Technology-Dependent Children During the COVID-19 Pandemic

Authors

Margaret Rush, Children's National Hospital, Washington, District of Columbia.
Amina Khan, Children's National Hospital, Washington, District of Columbia.
John Barber, Children's National Hospital, Washington, District of Columbia.
Miriam Bloom, Children's National Hospital, Washington, District of Columbia.
Melanie Anspacher, Children's National Hospital, Washington, District of Columbia.
Karen Fratantoni, Children's National Hospital, Washington, District of Columbia.
Kavita Parikh, Children's National Hospital, Washington, District of Columbia.

Document Type

Journal Article

Publication Date

1-1-2023

Journal

Hospital pediatrics

Volume

13

Issue

1

DOI

10.1542/hpeds.2021-006506

Abstract

BACKGROUND AND OBJECTIVE: During the coronavirus disease 2019 pandemic, technology-dependent children are at risk of encountering barriers to hospital discharge because of limits to in-home services. Transition difficulties could increase length of stay (LOS). With this study, we aim to (1) evaluate change in LOS and (2) describe barriers to hospital discharge between prepandemic and early pandemic periods for technology-dependent children. METHODS: A retrospective chart review of technology-dependent children discharged from an acute and specialty pediatric hospital within a single urban area between January 1 and May 28, 2020 was conducted. Technology dependence was defined by using a validated complex chronic condition coding system. Patients discharged prepandemic and during the pandemic were compared. Outcomes included LOS and the number and type of discharge barriers (a factor not related to a medical condition that delays discharge). Multivariate regression modeling and parametric and nonparametric analysis were used to compare cohorts. RESULTS: Prepandemic, 163 patients were discharged, and 119 were discharged during the early stages of the pandemic. The most common technology dependence was a feeding tube. The unadjusted median LOS was 7 days in both groups. After adjusting for patient-level factors, discharge during the pandemic resulted in a 32.2% longer LOS (confidence interval 2.1%-71.2%). The number of discharge barriers was high but unchanged between cohorts. Lack of a trained caregiver was more frequent during the pandemic (P = .03). CONCLUSIONS: Barriers to discharge were frequent for both cohorts. Discharge during the pandemic was associated with longer LOS. It was more difficult to identify a trained caregiver during the pandemic.

APA Citation

Rush, Margaret; Khan, Amina; Barber, John; Bloom, Miriam; Anspacher, Melanie; Fratantoni, Karen; and Parikh, Kavita, "Length of Stay and Barriers to Discharge for Technology-Dependent Children During the COVID-19 Pandemic" (2023). GW Authored Works. Paper 2332.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2332

Department

Pediatrics