156 - The association between home nursing & 30-day post-tracheotomy hospital readmission: A single-center prospective cohort study

Poster Number: 156
Publication Number: 156.305

Madison K. Lodge, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Ramon A. Durazo-Arvizu, Children's Hospital Los Angeles/University of Southern California, Los Angeles, CA, United States; Christopher J. Russell, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: Children with tracheostomy have high readmission rates after discharging post-tracheotomy. While home health nursing (HHN) has been shown to decrease hospital readmission in other populations, this has not been studied in children with tracheostomy.

Objective: Identify the association between HHN and hospital readmissions for patients discharged after tracheotomy.

Design/Methods: We conducted a single center prospective cohort study of children who underwent tracheotomy at Children’s Hospital Los Angeles, a quaternary free standing children’s hospital, between 12/2016-9/2021. We excluded patients with index length of stay (LOS) >345 days (outlier), were decannulated or died prior to discharge, or had < 30 days of post-discharge follow-up. We conducted chart review for the initial tracheostomy placement hospitalization and collected demographic, clinical, and discharge variables. We used multivariate analysis to test the association between our primary exposure, record of HHN after discharge, and our outcomes of 30-day all cause and respiratory-related readmission, adjusting for potential confounders. Given a significant interaction between home mechanical ventilation (HMV) and HHN, we conducted stratified analysis (HMV/no HMV).

Results: Of the 100 patients who met inclusion criteria, 52% were male, 60% Hispanic/Latino ethnicity, 39% were pre-term, and 67% had public insurance. Median LOS for index hospitalization was 97 days (IQR:62-155). 40% of patients had concurrent gastrostomy tube/tracheostomy placement and 59% of patients had a pre-tracheostomy neurologic comorbidity. 64% of patients were discharged with HMV and 60% were discharged with HHN. After discharge, 14% had at least one 30-day readmission, of which 64% were respiratory related (n=9/14). Adjusting for confounders, on multivariate analysis, for patients discharged with HMV, HHN was not associated with either 30-day all-cause [adjusted OR (aOR)=2; 95% CI: 0.3-12.3; p=0.46] nor respiratory-related readmissions (aOR=3.7; 95% CI: 0.4-37.4; p=0.27). For patients discharged without HMV, HHN was associated with decreased odds of 30-day all cause readmission (aOR=0.06; 95% CI: 0.01-0.55; p=0.01), but not respiratory readmissions (aOR=0.29; 95% CI: 0.03-2.9; p=0.29).Conclusion(s): For those discharged without HMV, HHN is associated with lower rates of 30-day all cause, but not respiratory-related, readmissions. Potentially, families with HHN in the first 30-days are better able to troubleshoot technology and tend to other health needs. Caregivers of children with HMV may have more training before discharge, mitigating HHN impact on readmissions.