Discharge Planning and Transition to Home Sarah Sexton Walters, APRN and Frank Virgin, MD Pediatric Otolaryngology Monroe Carell Jr. Children’s Hospital at Vanderbilt.
Disclosures I have no disclosures
Background Length of Stay Consistency and Assessment of Education Early Readmissions
Timeline Preoperative Phase Acute Phase Chronic Phase Case management, primary team and care providers will identify a goal discharge date. Rooming In Takes place in the days just prior to discharge. Admission to Discharge Tracheostomy to Discharge Global Tracheostomy Collaborative Report 1 August 2014-1 July 2016.
Discharge Checklist Homeward Bound Class Received Equipment Education from DME Demonstrated Competency in Bedside Skills: Stoma Care Gauze change Tie Change Suctioning with catheter Tracheostomy tube change Cleaning of tracheostomy tube Completed Rooming In
Rooming In Two identified caregivers 48 hours 72 hours for home vent Family caregivers responsible for all aspects of care Supplemental education Extension of process
Readmissions Trends of readmissions within 48 hours of discharge Identified risk factors for readmission DCS involvement Home Ventilator No Home Health Preventable causes Equipment malfunction Intolerance to home equipment Lack of family understanding on how to use home equipment Home health staffing
Home Equipment Use in the Hospital Setting Biomedical Engineering Evaluation Responsibility of the family, supervising physician and contracted DME All emergency and back-up equipment should be kept at the bedside and readily available for use In the event of equipment problems patient is transitioned back to hospital equipment under supervision of a staff member Communication regarding equipment issues and resolution prior to discharge - I was also thinking I would talk about how we’ve used this for chronic trach patients as well unless you think we should just focus on first time discharges.
Home Equipment Use Hospital Support DME Partnership Set up approval Staff education Planning Support from supervising consult teams Orders Equipment delivery and set up Family education Troubleshooting This is where I would talk about the different people and services that would need to be involved for implementing this protocol and what our experiences. I also will discuss the barriers we have seen from the hospital and DME
Home Health Private Duty Nursing Respiratory Care Limited training Scope of practice restrictions for LPNs Staffing availability Respiratory Care Lack of pediatric-trained therapists I would bring up problems with home health and the problems they have generated. What are we doing to fix this or have thought about doing. Will discuss what we’re doing to address these issues. What are the barriers to getting things changed.
Special Considerations Physical Rehabilitation Identify timeline goals for follow up DME Orders DCS/ Foster Care Caregiver training Length of stay Complex Care Follow up
Follow Up PCP follow up within 1 week Clinic follow up scheduled within 1 month of discharge Specialty care/ CADET
Contact Info sarah.l.sexton@vanderbilt.edu