Suchergebnisse

Objectives: To systematically assess barriers delaying home respiratory equipment requisition and to evaluate for temporal correlation between delays and emergency room or hospitalization episodes.Background: Initiation of home respiratory treatments is delayed because of delays in delivery of durable medical equipment (DME). This study assesses root causes of such delays from a system perspective. We also describe clinical consequences by measuring emergency room visits and hospitalization days for temporal correlations.Methods: We conducted a retrospective review of DME ordering records from April 2011 to March of 2012.Settings: Outpatient DME records in Pediatric Pulmonary Division.Results: Of 164 available orders studied, deliveries were made as followed: 31 (19%) within 24 hr: 18 (59%) oxygen orders and 10 (32%) nebulizer orders 50 (30%) within 1 week: 25 (50%) nebulizer orders and 10 (20%) oxygen orders Delays: 45 (27%) delivered > 1 month: Bilevel positive airway pressure (BPAP) = 16 (36%) Oxygen = 12 (26%) Cough assist device = 7 (16%) Nebulizer = 5 (11%) Miscellaneous devices = 5 (11%) Analysis of barriers includes (a) type of insurance, (b) human error, (c) communication barrier, (d) deficit in training or knowledge, (e) no clear policy, (f) differences in clinical policy/ standard, (g) no DME benefit, (h) no clinical justification, and (i) error in communication/record keeping. Six patients with 7 emergency department (ED) visits and 4 inpatient admissions, totaling 24 hospital days, were temporally associated with delays in delivery of equipment over 30 days.Conclusion: One half of commonly used DMEs were delivered within the first week. One quarter of more expensive required more steps for approval. Twenty-nine ED/hospital days with respiratory morbidities were temporally associated with delays.

How many chest radiographs prompt changes in therapy for home mechanical ventilation (HMV) patients admitted to the hospital for pneumonia? Since HMV patients are more complex than those with simple community-acquired pneumonia, it is not known how many chest radiographs are needed for optimal management. To answer this, we reviewed all HMV patients admitted for pneumonia from July 2007 through June 2008. Demographic data, sequential chest radiographs, and changes in respiratory orders within 24 hours were recorded. Childrens Hospital Los Angeles followed 180 HMV patients. Twenty-eight patients (16%) were admitted (36 readmissions). Twenty-five of these patients (90%) required full-time HMV. Eighteen patients (64%) had the diagnosis of chronic lung disease. On discharge, 24 patients (66%) had residual pneumonia on chest radiographs. We conclude that HMV patients averaged five chest radiographs per pneumonia admission. Two-thirds of the chest radiographs did not prompt subsequent changes in respiratory therapy. More than one-third of the chest radiographs found no interval changes. The majority of discharges were not contingent on resolution of the chest radiographs findings. We speculate that the frequency of chest radiographs could be less and that chest radiographs were not the sole predictors of changes in respiratory treatment or the decision to discharge.