380: READMISSION AND EMERGENCY DEPARTMENT VISIT RATES IN PEDIATRIC PATIENTS WITH NEW TRACHEOSTOMY

Abstract

Learning Objectives: Tracheostomy-dependent patients are a growing population in the pediatric intensive care unit. Due to the training and knowledge required to manage a patient with a tracheostomy, this population is vulnerable to readmission following discharge from the initial procedure. Despite advances in family and provider education, hospital healthcare utilization remains very high. Previous studies of pediatric patients over the past decade have demonstrated readmission rates ranging from 20–35% in the initial 1–3 month period following discharge. We investigated readmission rates and emergency department (ED) visits for pediatric patients discharged after undergoing tracheostomy. Methods: A retrospective chart review was performed of pediatric patients post-tracheostomy in the years 2015–2017 at an urban, free-standing children’s hospital to evaluate 30-day readmission rates and ED visits following discharge. Patients were identified through CPT procedural coding for tracheostomy. Manual chart review was performed to determine etiology for ED visit and admission. 51 patients were identified, with an age range of 1 day to 18 years at time of tracheostomy. 3 patients were excluded from the study: 2 who did not survive to discharge, and 1 who was transferred to another facility from the emergency department immediately following emergent tracheostomy. Results: Of the 48 patients included in final analysis, 31 were mechanically ventilated at time of discharge. 12 (25%) had a readmission within 30 days, 7 of whom were mechanically ventilated. Of the admissions, 7 (15% of total discharges) were directly related to respiratory complaints. No elective admissions occurred within 30 days of discharge. 17 (35%) had an ED visit within 30 days, 9 of whom were mechanically ventilated. Of the ED visits, 13 (27% of total discharged patients) were related directly to respiratory complaints. Conclusions: Pediatric patients with tracheostomy remain a vulnerable population with high likelihood of returning to hospital care within 30 days post-procedure, whether to the emergency department or an admission to the pediatric ICU. Based on the results of this study, rates of readmission have not demonstrated significant improvement in the past decade. The majority of these patients present with clear respiratory complaints which may be preventable. Further efforts in education and training of at-home and long-term care providers are needed to reduce healthcare utilization for this unique patient population.