Discharge Transportation for Initial Hospital Discharge of Tracheostomized Ventilator-Dependent Children

Background: National guidelines regarding type of transportation recommended for initial discharge of tracheostomized children requiring home mechanical ventilation are lacking. The standard practice at our institution is to use non-emergency ambulance services. However, these children have been deemed medically stable to discharge home and many families have their own transportation. The aim of this study was to identify discharge transportation practices used by children’s hospitals caring for these children. Methods: Clinicians involved in the care of tracheostomized ventilator-dependent children were invited to complete a survey regarding discharge transportation. The invitation was sent to the Neonatal Pediatrics section of AARC Connect and the Children’s Hospital Association discharge planning listserve in April 2024 and was available for 2 weeks. Responses were collected electronically. Institutions were grouped by regional location and only counted once when more than one response was received from the same institution. Results: There were 26 respondents representing 21 children’s hospitals. The majority of respondents were RTs (17, 65%) and most hospitals were located in the Southeastern US (10, 47%). The general service area was > 150 miles for 47% of hospitals. All institutions required a minimum of 2 trained caregivers and successful room-in prior to discharge. However, the duration of the room-in varied from 1 to ≥ 3 days. More than one mode of discharge transportation was used by 62% of all institutions. The most common methods were non-emergency ambulance or personal vehicle. Distance from the hospital and patient stability were the main criteria identified when ambulance and personal vehicle are used. Conclusions: The method of discharge transportation for ventilator-dependent children varies amongst children’s hospitals. Caregiver’s training requirements varied among institutions. Non-emergency ambulance and personal vehicle were the most reported methods of transportation for the initial discharge home for tracheostomized ventilator-dependent children.