720 - Pediatric Long-Term Acute Care for Children with Medical Complexity

Background: Children with medical complexity (CMC) often require life-sustaining care from pediatric subspecialists in tertiary care hospitals and intensive care units for their high levels of medical fragility over extended periods of time. Pediatric long-term acute care (LTAC) may offer a high-value alternative to prolonged tertiary care hospitalizations for these CMC, yet feasibility has not been well described.


 

Objective:

Objective:   To demonstrate the feasibility and describe the experience of a community based pediatric LTAC program integrated with an academic health center for CMC with technology dependencies requiring prolonged hospital care.

Design/Methods: Methods:  This is a descriptive study of CMC admitted to a single pediatric LTAC unit in a community-based, post-acute care facility in the Intermountain West between May 2012 and August 2022.  The facility has 10 pediatric LTAC and 20 SNF (skilled nursing facility) beds.  Faculty from a tertiary care, regional children’s hospital and affiliated medical school attend these children in an integrated system; the care team includes a pediatric hospitalist, pulmonologist, intensivist and physiatrist, who also consult prior to LTAC admissions and continue outpatient care in an academic complex care program.

Results:

Results:   A total of 131 CMC were admitted to pediatric LTAC; 51 (39%) were from NICU (Neonatal ICU), 45 (34%) from PICU/CICU (Pediatric ICU/Cardiac ICU), 27 (21%) from general hospital units, and 8 (6%) from home.  Nearly all children had respiratory technology dependencies, including tracheostomies/ventilators in 119 (91%) and non-invasive ventilation in 2 (2%).  Most CMC were admitted on hospital ventilators and discharged on home ventilators. Average length of stay was 136 days (range, 2-694, median 102 days). 12 (9%) remain on LTAC, 57 (44%) were discharged to home from LTAC, and 10 (8%) were discharged home via SNF. 4 (3%) died during admission, and 15 (11%) died within 180 days of discharge. Others were readmitted to the tertiary care hospital for planned (rehabilitation, surgical procedures) or unplanned events.

Conclusion(s):

Conclusions: Pediatric LTAC is a feasible, high-value component of the care continuum for CMC who need prolonged hospital/ICU level of care. As pediatric hospitals designed for short-term, acute care are tasked to care for growing numbers of CMC with long-term, technology-dependencies who are too unstable for care at home and for whom home nursing is unavailable, pediatric LTAC is a model of care worthy of consideration.