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- Title
Innovative Discharge Process for Families with Pediatric Short Bowel Syndrome: A Prospective Nonrandomized Trial.
- Authors
Raphael, Bram P.; Jorina, Maria; Gallotto, Mary; Grullon, Glendalis; Dalton, Meghan; Takvorian‐Bené, Melissa; Tascione, Christina; Rosa, Carolyn; McClelland, Jennifer; Gray, Megan; Potemkin, Alexis K.; Glavin, Courtney; Gura, Kathleen M.; Murphy, Margaret K.; Leger, Kierrah; Mahoney, Judith; Kerr, Jessica; Ozonoff, Al; Duggan, Christopher P.; Takvorian-Bené, Melissa
- Abstract
<bold>Background: </bold>Home parenteral nutrition (HPN) is a life-sustaining therapy for short bowel syndrome (SBS) and other severe digestive diseases, but complications are common. We evaluated a predischarge HPN hands-on training course to reduce complications in children with SBS, including hospital readmissions.<bold>Methods: </bold>We conducted a prospective, nonrandomized controlled research study between April 1, 2014, and April 30, 2017. Eligible participants were children aged <18 years old with SBS and anticipated HPN dependence duration ≥6 months. Excluded participants had a previous history of discharge with a central venous catheter (CVC), HPN, or intravenous fluids or strictly palliative goals of care. An intervention group practiced hands-on HPN within the hospital room for 24 hours using infusion equipment. The groups received standard teaching (CVC care, home infusion pump operation, HPN preparation and administration).<bold>Results: </bold>Nine children were assigned to the intervention group and 12 served as controls. The median age was 8.4 months, and length of stay (LOS) was 82 days. All participants experienced ≥1 event, with a total of 47 issues related to HPN. There were no significant associations between group assignment and 30-day postdischarge events. Each additional week of LOS was associated with 11% increase in the odds of an emergency department visit (OR 1.11; 95% CI, 1.01-1.26) and 16% increase in the odds of readmission (OR 1.16; 95% CI, 1.04-1.37).<bold>Conclusions: </bold>Postdischarge events remained widespread despite HPN bedside interventions offered by this pilot intervention. With refinement of HPN discharge processes, quality benchmarks are needed.
- Subjects
PARENTERAL feeding; SHORT bowel syndrome; PATIENT readmissions; CENTRAL venous catheters; CHILDREN
- Publication
JPEN Journal of Parenteral & Enteral Nutrition, 2018, Vol 42, Issue 8, p1295
- ISSN
0148-6071
- Publication type
journal article
- DOI
10.1002/jpen.1158