Gridlock on the road to recovery: Barriers to timely pediatric trauma rehabilitation.

Abstract

Recovery from pediatric injury frequently requires transfer to an inpatient rehabilitation facility (IRF) for further convalescence. Waiting for disposition to such facilities can substantially prolong hospitalization. This study sought to determine the root causes of delayed discharge following medical readiness for pediatric patients. The authors hypothesized that insurance disparities and the day of week patients were deemed ready for discharge would significantly delay disposition. A retrospective cohort study was performed by querying the authors' institutional database for patients admitted to a level 1 pediatric trauma center from January 1, 2016, to December 31, 2023. The date patients were documented as medically ready for discharge was identified and compared with the actual date of discharge. The root cause of delay was determined for each patient and factors contributing to extended discharge waits were analyzed. There were 162 patients identified with an average age of 9.4 ± 0.9 years and Injury Severity Score of 22.0 ± 1.9. The mean time to discharge after medical clearance was 3.6 ± 0.6 days which comprised 23 ± 6.1% of admission length on average. In-state residents had shorter waits than out-of-state residents (3.1 ± 0.5 vs. 6.2 ± 2.4 days, p = 0.016), as did those declared medically ready on Thursday or Friday (4.9 ± 1.4 vs. 3.0 ± 0.6 days, p = 0.012). The most common root causes of delay were rehabilitation bed availability, insurance authorization, and weekend delays. Having commercial insurance versus Medicaid had no impact. While waiting for rehabilitation, two patients (1.2%) developed pressure ulcers, one (0.6%) developed a deep vein thrombosis, and one (0.6%) developed a urinary tract infection. An average of 6.5% of inpatient monetary charges were incurred during the wait period. Length of stay after severe pediatric injury is significantly impacted by time spent waiting for transfer to inpatient rehabilitation. Delayed transfer prevents optimal care and harms patient flow. Optimizing care transitions, identifying commonalities with other trauma centers, and considering government advocacy are warranted. Therapeutic/Care Management; Level IV.