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 reveiwed 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