Pediatric Grand Rounds

1. Describe the pathway to discharge on home mechanical ventilation;
2. Describe patient factors associated with high hospital costs; and
3. Describe hospital factors associated with high hospital costs.

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Physicians

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References for this presentation: 

 1. Benneyworth BD, Gebremariam A, Clark SJ, Shanley TP, Davis MM. Inpatient health care utilization for children dependent on long-term mechanical ventilation. Pediatrics. 2011;127(6):e1533-e41.

 2. Chau SK, Yung AW, Lee SL. Long-Term Management for Ventilator-Assisted Children in Hong Kong: 2 Decades' Experience. Respiratory care. 2017;62(1):54-64. Epub 2016/12/03. doi: 10.4187/respcare.04989. PubMed PMID: 27899532.

 3. Amin RS, Fitton CM. Tracheostomy and home ventilation in children. Seminars in Neonatology.8(2):127-35. PubMed PMID: 15001149.

 4. Watters K, O'Neill M, Zhu H, Graham RJ, Hall M, Berry J. Two-year mortality, complications, and healthcare use in children with medicaid following tracheostomy. Laryngoscope.126(11):2611-7. PubMed PMID: 27060012.

 5. Reiter K, Pernath N, Pagel P, Hiedi S, Hoffmann F, Schoen C, et al. Risk factors for morbidity and mortality in pediatric home mechanical ventilation. Clinical Pediatrics.50(3):237-43. PubMed PMID: 21127085.

 6. Fields AI. Pediatric tracheostomy: the great liberator or the last battlefield? Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2008;9(1):126-7. Epub 2008/01/11. doi: 10.1097/01.pcc.0000298655.36899.4a. PubMed PMID: 18185130.

 7. Messineo A, Giusti F, Narne S, Mognato G, Antoniello L, Guglielmi M. The safety of home tracheostomy care for children. Journal of Pediatric Surgery.30(8):1246-8. PubMed PMID: 7472995.

 8. Meier JD, Valentine KJ, Hagedorn C, Hartling C, Gershan W, Muntz HR, et al. Emergency department use among children with tracheostomies: Avoidable visits. Journal of pediatric rehabilitation medicine. 2015;8(2):105-11. Epub 2015/09/28. doi: 10.3233/prm-150324. PubMed PMID: 26409864.

 9. Wilcox LJ, Weber BC, Cunningham TD, Baldassari CM. Tracheostomy Complications in Institutionalized Children with Long-term Tracheostomy and Ventilator Dependence. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2016;154(4):725-30. Epub 2016/02/18. doi: 10.1177/0194599816628486. PubMed PMID: 26884369.

 10. Hsia SH, Lin JJ, Huang IA, Wu CT. Outcome of long-term mechanical ventilation support in children. Pediatrics & Neonatology.53(5):304-8. PubMed PMID: 23084723.

 11. Kun SS, Edwards JD, Ward SL, Keens TG. Hospital readmissions for newly discharged pediatric home mechanical ventilation patients. Pediatric pulmonology. 2012;47(4):409-14. Epub 2011/09/09. doi: 10.1002/ppul.21536. PubMed PMID: 21901855; PubMed Central PMCID: PMCPMC3694986.

 12. Graf JM, Montagnino BA, Hueckel R, McPherson ML. Pediatric tracheostomies: a recent experience from one academic center. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2008;9(1):96-100. Epub 2008/05/15. doi: 10.1097/01.pcc.0000298641.84257.53. PubMed PMID: 18477921.

 13. Sobotka SA, Hird-McCorry LP, Goodman DM. Identification of Fail Points for Discharging Pediatric Patients With New Tracheostomy and Ventilator. Hospital pediatrics.6(9):552-7. PubMed PMID: 27538680.

 14. Cristea AI, Ackerman VL, Davis SD, Carroll AE, Downs SM, Yu Z, et al. Median Household Income: Association with Mortality in Children on Chronic Ventilation at Home Secondary to Bronchopulmonary Dysplasia. Pediatric allergy, immunology, and pulmonology. 2015;28(1):41-6. Epub 2015/04/09. doi: 10.1089/ped.2014.0406. PubMed PMID: 25852968; PubMed Central PMCID: PMCPMC4365512.

 15. McPherson ML, Shekerdemian L, Goldsworthy M, Minard CG, Nelson CS, Stein F, et al. A decade of pediatric tracheostomies: Indications, outcomes, and long-term prognosis. Pediatric pulmonology. 2017;52(7):946-53. Epub 2017/03/07. doi: 10.1002/ppul.23657. PubMed PMID: 28263440.

 16. Dursun O, Ozel D. Early and long-term outcome after tracheostomy in children. Pediatrics international : official journal of the Japan Pediatric Society. 2011;53(2):202-6. Epub 2010/07/30. doi: 10.1111/j.1442-200X.2010.03208.x. PubMed PMID: 20667029.

 17. Spentzas T, Auth M, Hess P, Minarik M, Storgion S, Stidham G. Natural course following pediatric tracheostomy. Journal of intensive care medicine. 2010;25(1):39-45. Epub 2010/01/23. doi: 10.1177/0885066609350874. PubMed PMID: 20095079.

 18. Edwards JD, Kun SS, Keens TG. Outcomes and causes of death in children on home mechanical ventilation via tracheostomy: an institutional and literature review. The Journal of pediatrics. 2010;157(6):955-9 e2. Epub 2010/08/18. doi: 10.1016/j.jpeds.2010.06.012. PubMed PMID: 20713294.

 19. Cristea AI, Carroll AE, Davis SD, Swigonski NL, Ackerman VL. Outcomes of children with severe bronchopulmonary dysplasia who were ventilator dependent at home. Pediatrics. 2013;132(3):e727-34. Epub 2013/08/07. doi: 10.1542/peds.2012-2990. PubMed PMID: 23918888; PubMed Central PMCID: PMCPMC3876749.

 20. Graham RJ, McManus ML, Rodday AM, Weidner RA, Parsons SK. Pediatric Specialty Care Model for Management of Chronic Respiratory Failure: Cost and Savings Implications and Misalignment With Payment Models. Pediatric Critical Care Medicine. 9000;Publish Ahead of Print. doi: 10.1097/pcc.0000000000001472. PubMed PMID: 00130478-900000000-98495.

 21. Baker CD, Martin S, Thrasher J, Moore HM, Baker J, Abman SH, et al. A Standardized Discharge Process Decreases Length of Stay for Ventilator-Dependent Children. Pediatrics. 2016;137(4). Epub 2016/03/12. doi: 10.1542/peds.2015-0637. PubMed PMID: 26966133; PubMed Central PMCID: PMCPMC4811306.

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