Obstacles to discharge of ventilator-assisted children from the hospital to home.

Home care for ventilatory-assisted children improves psychosocial development and reduces medical costs compared with hospital care; yet, many ventilator-assisted children remain hospitalized for lengthy periods of time after they have achieved medical stability. To identify factors that contributed to a delay in hospital discharge from the time medical stability was achieved, we reviewed the records of 54 ventilator-assisted children (age 4.6 +/- 5.9 [SD] years at discharge) who were discharged from the hospital on a regimen of home mechanical ventilation. The length of the hospitalization from which the ventilator-assisted children were initially discharged on the ventilator was 172 +/- 161 days (range, 2 to 756). The time from medical stability to discharge was 118 +/- 144 days (range, 2 to 724), or 73 percent +/- 29 percent of the total hospitalization. Fifty-one ventilator-assisted children were discharged to their natural parents' homes, and three were discharged to foster care. Once ventilator-assisted children were medically stable, it took 99 +/- 141 days for third-party payers to approve home care funding, and only 48 +/- 87 days to be discharged once funding was approved. For the 27 ventilator-assisted children with public funding, it took 184 +/- 177 days for home care funding approval, compared with 52 +/- 43 days for the 27 ventilator-assisted children with private funding (p < 0.001). Parent training took only 52 +/- 65 days. It took 369 +/- 334 days (range, 44 to 711 days) to find placement for the three ventilator-assisted children who were placed in medical foster care. In summary, ventilator-assisted children often remained hospitalized for prolonged periods of time, after they were medically stable, for nonmedical reasons. The greatest obstacle to hospital discharge was seeking approval for home care funding and for arranging out-of-home placement. Public funding agencies took significantly longer to approve home care funding than private insurance agencies.