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Direct Discharge to Home From the Pediatric Cardiovascular ICU. | LitMetric

Direct Discharge to Home From the Pediatric Cardiovascular ICU.

Pediatr Crit Care Med

Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.

Published: April 2022

AI Article Synopsis

  • The study aimed to evaluate the process and outcomes of discharging patients directly from the cardiovascular ICU to their homes, analyzing data from various pediatric heart centers from 2016 to 2020.
  • A total of 364 patients were included, mostly those who had undergone surgery, with a low 7-day readmission rate of 1.9% compared to 4.6% for those discharged from acute care.
  • Frontline providers expressed varied levels of confidence regarding the technical and logistical aspects of direct discharges, highlighting a need for improved training and support.

Article Abstract

Objectives: To describe direct discharge to home from the cardiovascular ICU.

Design: Mixed-methods including retrospective Pediatric Cardiac Critical Care Consortium and Pediatric Acute Care Cardiology Collaborative data and survey.

Setting: Tertiary pediatric heart center.

Patients: Patients less than 25 years old, with a cardiovascular ICU stay of greater than 24 hours and direct discharge to home from January 1, 2016, to December 8, 2020, were included. Select data describing patients discharged from acute care internally and nationally from Pediatric Acute Care Cardiology Collaborative sites were compared with the direct discharge to home cohort.

Interventions: None.

Measurements And Main Results: Encounter- and patient-specific characteristics. Seven-day and 30-day readmission and 30-day mortality served as surrogate safety markers. A survey of cardiovascular ICU frontline providers assessed comfort and skills related to direct discharge to home.There were 364 direct discharge to home encounters that met inclusion criteria. The majority of direct discharge to home encounters were associated with a surgery or procedure (305; 84%). There were 27 encounters (7.4%) for medical technology-dependent patients requiring direct discharge to home. Unplanned 7-day readmissions among direct discharge to home patients was 1.9% compared with 4.6% (p = 0.04) of patients discharged from acute care internally. Readmission among those discharged from acute care internally did not differ from those at Pediatric Acute Care Cardiology Collaborative sites nationally. Frontline cardiovascular ICU providers had mixed levels of confidence in technical aspects and low levels of confidence in logistics of direct discharge to home.

Conclusions: Cardiovascular ICU direct discharge to home was not associated with increased unplanned readmissions compared with patients discharged from acute care and may be safe in select patients. Frontline cardiovascular ICU providers feel time constraints challenge direct discharge to home. Further research is needed to identify patient characteristics associated with safe direct discharge to home and systems needed to support this practice.Summary statistics are described using proportions or medians with interquartile ranges (IQRs) and were performed using Microsoft Excel (Microsoft, Redmond, WA). Two-sample tests of proportions were used to compare readmission frequency of the DDH cohort compared with internal and national PAC3 data using STATA Version 15 (StataCorp, College Station, TX).

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Source
http://dx.doi.org/10.1097/PCC.0000000000002883DOI Listing

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