1. Discharge Planning and Transition to Home
Sarah Sexton Walters, APRN and Frank Virgin, MD
Pediatric Otolaryngology
Monroe Carell Jr. Children’s Hospital at Vanderbilt.

2. Disclosures
I have no disclosures

3. Background Length of Stay Consistency and Assessment of Education
Early Readmissions

4. 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 July 2016.

5. 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

6. 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

7. 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

8. 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.

9. 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

10. 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.

11. Special Considerations
Physical Rehabilitation
Identify timeline goals for follow up
DME Orders
DCS/ Foster Care
Caregiver training
Length of stay
Complex Care
Follow up

12. Follow Up PCP follow up within 1 week
Clinic follow up scheduled within 1 month of discharge
Specialty care/ CADET

13. Contact Info