Technology-dependency among patients discharged from a children's hospital: a retrospective cohort study

Abstract

Background: Advances in medical technology may be increasing the population of children who are technology-dependent (TD). We assessed the proportion of children discharged from a children's hospital who are judged to be TD, and determined the most common devices and number of prescription medications at the time of discharge.

Methods: Chart review of 100 randomly selected patients from all services discharged from a children's hospital during the year 2000. Data were reviewed independently by 4 investigators who classified the cases as TD if the failure or withdrawal of the technology would likely have adverse health consequences sufficient to require hospitalization. Only those cases where 3 or 4 raters agreed were classified as TD.

Results: Among the 100 randomly sampled patients, the median age was 7 years (range: 1 day to 24 years old), 52% were male, 86% primarily spoke English, and 54% were privately insured. The median length of stay was 3 days (range: 1 to 103 days). No diagnosis accounted for more than 5% of cases. 41% were deemed to be technology dependent, with 20% dependent upon devices, 32% dependent upon medications, and 11% dependent upon both devices and medications. Devices at the time of discharge included gastrostomy and jejeunostomy tubes (10%), central venous catheters (7%), and tracheotomies (1%). The median number of prescription medications was 2 (range: 0-13), with 12% of cases having 5 or more medications. Home care services were planned for 7% of cases.

Conclusion: Technology-dependency is common among children discharged from a children's hospital.

Figure 1

Goal and means for the understanding of technology-dependency.

Figure 2

Dimensions of dependency on technology. Examples enclosed in parentheses are meant only to illustrate extremes of the dimensions. CSF, cerebrospinal fluid; MDI, metered dose inhaler.

Figure 3

Definitions of technology-dependent.

Figure 4

Proportion of subjects with technology dependency or special health care needs. The span of each bar represents the proportion of the sample that exhibited the specified characteristic. The overlapping position of the bars vis-à-vis each other represents the proportion of subjects who exhibited several of these characterizes. Medications, Devices, and Both (medications and devices) indicate sub-types of technology-dependence.