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A Framework of Pediatric Hospital Discharge Care Informed by Legislation, Research, and Practice

Jay G. Berry, MD, MPH1,2; Kevin Blaine, MAEd1; Jayne Rogers, MSN, RN, NEA-BC, CPHQ3; Sarah McBride, MD1,2; Edward Schor, MD4; Jackie Birmingham, BSN, MS, RN, CMAC5; Mark A. Schuster, MD, PhD1,2; Chris Feudtner, MD, PhD, MPH6,7,8
[+] Author Affiliations
1Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
2Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
3Department of Nursing, Boston Children’s Hospital, Boston, Massachusetts
4Lucile Packard Foundation for Children’s Health, Palo Alto, California
5Curaspan Health Group Inc, Newton, Massachusetts
6Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
7Department of Pediatrics, University of Pennsylvania, Philadelphia
8Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
JAMA Pediatr. 2014;168(10):955-962. doi:10.1001/jamapediatrics.2014.891.
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To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10 000 pediatric discharges per day in the United States. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality-improvement efforts, and adversely affects the health and well-being of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal law within the Social Security Act that outlines standards for hospital discharge; a variety of toolkits that aim to improve discharge care; and the research evidence that supports the discharge process. We then outline a framework within which to organize the diverse activities that constitute discharge care to be executed throughout the hospitalization of a child from admission to the actual discharge. In the framework, we describe processes to (1) initiate pediatric discharge care, (2) develop discharge care plans, (3) monitor discharge progress, and (4) finalize discharge. We contextualize these processes with a clinical case of a child undergoing hospital discharge. Use of this narrative review will help pediatric health care professionals (eg, nurses, social workers, and physicians) move forward to better understand what works and what does not during hospital discharge for children, while steadily improving their quality of care and health outcomes.

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A Framework of Pediatric Hospital Discharge Care
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