541 - Fast Track to Full Feeds: Redesigning Pediatric Hospital Discharge Using a New Transitions of Care Model

Publication Number: 541.4599

Jessica Santucci, Pennsylvania State University College of Medicine, Hershey, PA, United States; Abigail E. Nelson, Penn State Children's Hospital, Hummelstown, PA, United States; Michael Beck, Penn State Health, Hershy, PA, United States

Background: Patients requiring tube feeds occupy significant pediatric bed space and incur high hospital costs, often without needing continuous inpatient monitoring. To address this challenge, we established a Post-Discharge Care Clinic (PDCC) for medically stable patients with unmet needs. Previous models in NICU settings have demonstrated improved outcomes, including faster progression to full oral feeds, no increase in adverse events, and cost savings (1-7).

Objective: As the first pediatric hospitalist-run clinic for recently discharged patients, our study aims to evaluate the effectiveness of the PDCC. We hypothesize that this approach will significantly reduce inpatient length of stay (LOS) without increasing readmissions or emergency department visits.

Design/Methods: We conducted a retrospective chart review of pediatric patients admitted to the PDCC for nasogastric (NG) or nasojejunal (NJ) tube follow-up from July 2019 to July 2021. Inclusion criteria included patients under 24 months with an inpatient LOS greater than 24 hours and documented nasoenteric feeding orders. A total of 57 patients were analyzed. The primary outcome measure was inpatient LOS with secondary outcome measures of ED visits, readmissions, cost savings, and time to achieve full oral feeds. Statistical analyses were performed using SAS version 9.4, with significance set at p< 0.05.

Results: Patients in the PDCC had a median age of 2 months and a median LOS of 6 days. Notably, 26 (50.9%) patients achieved full oral feeds within a median of 24.5 days post-discharge. The implementation of the PDCC was associated with an estimated average reduction of 18.5 inpatient days per patient, translating to significant cost savings of $7,424.40 per patient. Moreover, 71.9% of patients had no ED visits, and 77.2% did not experience readmissions within 30 days post-discharge, with results comparable to published literature (8).

Conclusion(s): This study demonstrates that the PDCC effectively reduces inpatient LOS while ensuring full oral feeds without increasing emergency department visits or readmissions. By lowering healthcare costs and enhancing patient and caregiver experiences—especially in underserved areas and among Medicaid populations—the PDCC shows potential for broader application across various pediatric conditions. Future research should evaluate its effectiveness for older children and adolescents, assess long-term outcomes, and conduct detailed cost-benefit analyses. Refining the PDCC model could further reduce costs, improve pediatric care, and address critical healthcare disparities.