Discharge of respiratory-compromised children after respiratory rehabilitation.

BACKGROUND

There is a growing demand for respiratory rehabilitation services for children dependent on tracheostomy and/or chronic mechanical ventilation. Discharging these patients home following their rehabilitation can be an arduous process.

OBJECTIVES

To define the length of time required to rehabilitate and discharge these patients, and to identify predictors of a prolonged or failed discharge process.

METHODS

We conducted a retrospective chart review of patients admitted to the Respiratory Rehabilitation Unit at Alyn Hospital, Jerusalem, over a 4 year period.

RESULTS

Of the 48 patients identified, 31 (64.7%) were eventually discharged, 13 (27.1%) remained hospitalized long-term, and 4 (8.3%) died during their hospitalization. The median length of hospitalization was 10 months: 6 months for purposes of rehabilitation therapy, and 4 months thereafter to resolve the logistics of discharge. Specific family characteristics--an unemployed father (odds ratio = 4.6, P = 0.02) and an additional family member with a disability (OR = 5.8, P = 0.03)--as well as ongoing mechanical ventilation at the time of discharge (OR = 5.5, P < 0.01) were found to positively correlate with a prolonged or failed discharge process.

CONCLUSIONS

Hospitalization in a pediatric respiratory rehabilitation unit may be prolonged for both medical and non-medical reasons, with the process of discharge home being particularly difficult in certain subsets of patients. A proactive discharge policy by hospitals, improved community support services, and legislation defining the rights of home-ventilated children may facilitate more efficient discharge home of these patients.