Research investigating root causes is sparse.

What are the root causes for these backups? The intersection of these challenges can further delay hospital discharge. Children in foster care are more likely to have medical needs and behavioral health needs. Some children fall into multiple groups at once. Even children with relatively ‘simple’ home-nursing needs may have prolonged wait times because of nurse staffing shortages across the board. Thus, many of these children need shift-based, highly-skilled home nursing care, which is in short supply. In the case of children with complex medical conditions, technology-dependence, such as the need for tracheostomy and ventilator due to pulmonary or neurologic disease, makes it difficult for parents and caregivers to provide all the needed home care. They fall into three general groups: children with behavioral health needs (a rapidly growing population, as covered recently by the New York Times), children with complex medical conditions, and children with involvement in the child welfare system. Are there certain conditions that make children more vulnerable to long delays in discharge? That is, they remained in the hospital for an average of 30 days after the point of medical clearance. In 2021, children at our hospital awaiting facility placement or private duty home nursing had an average delay of 30 days. Most are delayed due to a lack of nursing facility beds or nursing staff and a lack of behavioral health care placement, while others are awaiting placement by the Pennsylvania Department of Human Services. Right now in our hospital there are more than 40 children waiting to be discharged.

In the hospital you studied, how many children are waiting for discharge at any given time? We asked them to explain more about the situation and their recommendations. In response to the problem of missing data and avoidable delays more broadly, a team including Penn LDI Associate Fellow Zoe Bouchelle, Senior Fellows Evan Fieldston and Chén Kenyon, Children’s Hospital of Philadelphia (CHOP) Senior Director of Case and Care Management Michele Hillman, and CHOP Pediatrician Emma Hackel offered their perspective on what should be done. Unfortunately, there is no way to estimate the length of such wait times nationally, as the current measure of “unnecessary hospital days” also includes short-term delays for services like specialist visits and lab orders. What’s more, evidence suggests that there are racial disparities in children’s length of stay, meaning this problem disproportionately affects minority families. Information from other facilities paints an even more concerning picture, with a 2019 study finding that children with complex conditions waited an average of 52 more days after being medically cleared to leave due to delays with establishing home nursing and other challenges. Children who had to stay in the hospital even after they were medically cleared to leave waited an average of 30 days before being able to transfer to a more appropriate facility, according to data from a large urban children’s hospital.

Theme hospital research stuck