Pediatric post-acute care hospital transitions: an evaluation of current practice.

OBJECTIVES: After discharge from an acute care hospital, some children require ongoing care at a post-acute care hospital. Care transitions occur at both admission to the post-acute care hospital and again at discharge to the home/community. Our objective was to report the current practices used during the admission to and discharge from 7 pediatric post-acute care hospitals in the United States. METHODS: Participants from 7 pediatric post-acute care hospitals completed a survey and rated the frequency of use of 20 practices to prepare and support children and their families during both admission to the hospital and at time of discharge to the home/community. For consistency with existing literature, practices were grouped into 4 previously reported categories: assessment, communication, education, and logistics. Descriptive statistics were used to report the frequency of use within practices and between hospitals. RESULTS: Only 2 of 10 admission practices and 3 of 10 discharge practices were reportedly "always" used by all hospitals. Assessment and communication practices were reported to be more frequently used (57%-100% of the time) than education and logistic procedures. Between hospitals, only the reported frequency of use of the discharge practices was statistically significantly different (P = .03). CONCLUSIONS: Variability exists in transition practices among 7 post-acute care pediatric hospitals. This report is the first known to detail the frequency of use of admission and discharge practices for pediatric post-acute care hospitals in the United States.

The safety of tracheostomy speaking valve use during sleep in children: a pilot study.

PURPOSE: One of the disadvantages of having a tracheostomy tube is not being able to vocalize. A speaking valve connected to a tracheostomy tube allows patients to vocalize. Some studies have shown that tracheostomy-speaking valve can improve swallowing, respiratory secretion management, and expedite decannulation. There is scant research about speaking valve use during sleep. The aim of this study is to evaluate the safety of tracheostomy-speaking valve overnight, during sleep. MATERIALS AND METHODS: Children, ages 1-18 years, with tracheostomy tubes who were using a tracheostomy-speaking valve during daytime/awake periods, were included in this study. The subjects had baseline monitoring of their heart rate, respiratory rate, oxygen saturation, and end tidal carbon dioxide measurement the night prior to the intervention, throughout the night at scheduled intervals. The tracheostomy-speaking valve was placed the following night and the same parameters were monitored and recorded throughout the study night. RESULTS: A total of 9 patients were recruited. In all subjects, the mean values of the overnight parameters showed no significant clinical variations between the baseline night and the study night. Repeated measure ANOVA analysis revealed no significant changes in the parameters over the 8 hours of recorded time. No major adverse events were recorded during the study night. CONCLUSION: This pilot study reveals that use of a tracheostomy-speaking valve during sleep, was not associated with adverse cardiopulmonary events. This is the first study to show that a tracheostomy-speaking valve might be safely used during sleep, in children.

Outcomes of post-acute hospital episodes for young children requiring airway support.

In this descriptive study, we examined changes in invasive and non-invasive airway support; studied the rates of home discharge vs. long-term care or acute hospitalization; and examined the relationship between the level of airway support and discharge to home for 92 children (<3 years of age) with 104 admission-discharge episodes to a consortium of pediatric rehabilitation hospitals over a one-year period. We found a significant reduction (p < 0.001) in the level of airway support between admission and discharge. In 21 of 47 (45%) episodes, children weaned from mechanical ventilation to a less restrictive type of support. Sixty percent of the children had final discharges to home. There was a significant, though fair correlation (Spearman Rho = -0.344, p = 0.001) between home discharge and level of airway support. These outcomes data provide a multi-site baseline for understanding expected changes in airway support and home discharge rates of young children who are admitted to a post-acute inpatient program.

The effectiveness of risperidone in the treatment of three children with feeding disorders.

Children with histories of extensive medical interventions in early childhood, especially those involving the gastrointestinal tract, are at-risk for residual feeding problems long after the medical issues have resolved. This case series describes the inpatient multidisciplinary treatment of 3 consecutive preadolescent children (ages 9, 8, and 7 years) admitted to our rehabilitation facility. Each child was admitted with a severe feeding disorder and histories of failure-to-thrive (FTT) that had required enteral nutritional interventions. Each child also had comorbid anxiety and mood symptoms. The addition of risperidone to behavioral and psychopharmacologic treatments was observed to significantly increase oral intake and accelerate weight gain. In 2 of 3 patients, assistive feeding interventions were successfully discontinued; and in a 3rd patient, enteral nutritional support was reduced by 74%. These cases suggest that risperidone may be a safe and effective adjunctive treatment, when behavioral feeding therapy is not sufficiently successful for children who have chronic and complicated medical and psychiatric presentations.