Barriers and Facilitators to a Safe Discharge for High-Risk Children With Congenital Heart Disease

Abstract

Objective: Children with congenital heart disease (CHD) often require continued care after hospital discharge by parents and other caregivers (P/CG), many of whom report problems in the transition to home and outpatient settings. Few studies have comprehensively assessed the perspectives of both P/CG and health care personnel (HCP) to identify factors affecting a safe discharge for medically or socially high-risk children with CHD.

Methods: Semistructured qualitative interviews concerning discharge processes and procedures were performed with 16 P/CG of medically or socially high-risk children with CHD (eg, receiving tube feeding) who experienced poor discharge outcomes (eg, unplanned 30-day readmissions) and 16 HCPs involved in their care. Interview transcripts were coded and analyzed using a thematic analysis approach.

Results: Four themes were constructed from the qualitative data: 1) teaching and communication to promote a safe discharge, 2) complexity of care influences a safe discharge, 3) P/CG presence at the bedside facilitates a safe discharge, and 4) leveraging technology as a tool to promote a safe discharge. For each theme, barriers, facilitators, and recommendations for additional support were identified.

Conclusion: Through their experiences, P/CG, as well as HCPs of children with complex medical conditions, can help identify barriers, facilitators, and recommendations for a safe discharge. Incorporating the perspectives of both groups has the potential to inform improvements in patient care and discharge processes for medically and socially high-risk children.