Johns Hopkins University School of Medicine (R Seltzer and PK Donohue), Baltimore, Md; Berman Institute of Bioethics (R Seltzer), Baltimore, Md; Johns Hopkins Bloomberg School of Public Health (R Seltzer, BD Watson, and PK Donohue), Baltimore, Md.
Johns Hopkins Bloomberg School of Public Health (R Seltzer, BD Watson, and PK Donohue), Baltimore, Md.
Acad Pediatr. 2022 Nov-Dec;22(8):1452-1458. doi: 10.1016/j.acap.2022.07.005. Epub 2022 Jul 11.
To elucidate challenges to timely hospital discharge of children in foster care (CFC).
Inpatient providers with prior experience caring for CFC were recruited from 6 mid-Atlantic hospitals. Semi-structured interviews were conducted to explore provider experience discharging CFC. Conventional content analysis was applied to interview transcripts with Dedoose software.
Interviews were completed with 15 MDs/NPs, 11 RNs, 10 social workers, and 2 case managers. Participants explained that delayed discharge is the norm for CFC, especially for those entering new foster care placements. Participants detailed challenges to efficiently discharging CFC, which were categorized into 3 themes: 1) Waiting for discharge disposition: Providers' ability to proceed with discharge planning is contingent on procedural steps (eg, court decisions) needed to determine disposition (eg, entering new foster care placement); 2) Medically cleared, but no place to go: Participants report placement searches are often not initiated by child welfare until the child is medically cleared. Lack of available, appropriate foster care placements delays discharge, particularly for children with complex medical or behavioral diagnoses; 3) Coordinating for a safe discharge: Establishing a safe discharge for CFC involves meticulous discharge planning, foster parent training, and multidisciplinary team communication/coordination.
Delayed discharge for CFC is multifactorial, yet often predictable. There are modifiable factors identified that can be addressed to promote timely hospital discharge and prevent medically unnecessary hospital days, benefitting patients in foster care and the hospital system.
阐明寄养儿童（CFC）及时出院面临的挑战。
从 6 家大西洋中部医院招募了有照顾 CFC 经验的住院医生/护士。采用半结构式访谈方法，探讨提供者在为 CFC 提供服务时的经验。使用 Dedoose 软件对访谈记录进行常规内容分析。
完成了对 15 名医生/护士、11 名护士、10 名社工和 2 名个案经理的访谈。参与者解释说，寄养儿童的延迟出院是一种常态，尤其是那些进入新寄养安置的儿童。参与者详细说明了有效为 CFC 办理出院的挑战，这些挑战分为 3 个主题：1）等待出院安排：提供者进行出院计划的能力取决于确定安置（如进入新的寄养安置）所需的程序步骤（如法院判决）；2）医学上已康复，但无处可去：参与者报告说，儿童福利机构通常不会在儿童接受医学检查之前开始寻找安置地点。缺乏可用的、合适的寄养安置地点会延迟出院，特别是对于患有复杂医疗或行为诊断的儿童；3）协调安全出院：为 CFC 建立安全出院需要精心的出院计划、寄养父母培训以及多学科团队的沟通/协调。
CFC 的延迟出院是多因素的，但通常是可以预测的。确定了一些可修改的因素，这些因素可以得到解决，以促进及时出院，并防止不必要的医疗住院天数，从而使寄养儿童和医院系统受益。
