Transition from Hospital to Home Following Hematopoietic Stem Cell Transplantation

Abstract

Topic Significance & Study Purpose/Background/Rationale Transition from hospital to home following hematopoietic stem cell transplantation (HSCT) is a challenging and vulnerable time for the caregiver due to the complexity of care needed in the home and may increase the risk of readmission. Methods, Intervention, & Analysis The “rooming in” intervention consists of 24-48 hours prior to discharge, the caregiver assumes all care requiring coordination of medications, feedings, line care and other needs with the RN.\xa0 Discharge education is completed prior to initiating rooming in. The objective of this study is to evaluate if the current clinical practice of “rooming in” decreases readmission rates within 30 days post-discharge for HSCT patients.\xa0 Secondary goals include describing the caregiver s perspective of the transition from hospital to home measured by post-discharge coping, hospital discharge readiness, and the quality of the discharge process.\xa0 This 2-group, non-concurrent study compared readmission rates between 35 historical controls and 35 prospective patients who received the “rooming-in” intervention prior to discharge. Findings & Interpretation Prospective group patient demographics include ages 9 months to 17 years with an average length of stay of 48 days. 28 patients received allogeneic and 7 received autologous transplants. Retrospective patient demographics include ages from 13 months to 21 years with an average length of stay of 43 days. 27 patients received allogeneic and 8 received autologous transplants.\xa0 Common themes expressed by the families regarding the transition to home are difficult without support of family, difficulty of juggling patient care with other dependents and work, complexity of medication regimen and compliance, and diet requirements. The number of home medications discharged with are significantly associated with the Post-Discharge Coping Difficulty score. Preparation using the Rooming-In intervention does not make a statistically significant difference in readmission rates between the two cohorts. Discussion & Implications A “rooming in” program provides preparation, oversight, and reassurance by the medical team for caregivers. Rooming in allows the provider to identify deficits that the caregiver may struggle with in the home that may result in unnecessary readmissions or poor compliance.