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Transitioning from Hospital to Home

Transitioning from hospital to home on a mechanical ventilator requires careful planning and extensive patient and family preparation. An average of 2 weeks is needed to complete the home discharge process.

Once it is determined that a patient is ventilator-dependent, plans should begin to transition the patient from hospital to an alternate setting. When evaluating the placement alternatives, the home setting is the one that affords the ventilator-dependent patient with the greatest independence, the best quality of life, and the lease costly care setting as compared to all other alternative along the continuum of care. Although the home setting might seen an attractive alternative, a successful home discharge requires careful planning and extensive patient and family preparation.

Discharge planning works best when a team of multidisciplinary health-care professionals works on the process together. The physician, primary RN, social service, insurance provider and case manager, home care nursing agency, and the home medical equipment (HME) provider and respiratory therapist should meet early in the discharge process to work through any obstacles to a successful discharge.

  1. A Respiratory Therapist from Access Healthcare Services & Supplies, LLC (AHSS) will make an appointment to meet with the patient and family members and evaluate the patient’s clinical condition and pay particular attention to his/her ventilator settings.  Pre-discharge criteria includes but not limited to:
  2. Being medically stable. They must not have untreated sepsis, hemodynamic instability, uncontrolled arrhythmia, or any other medical or surgical condition that will require readmission to an acute facility within the first month after discharge.
  3. The patient must have a safe and secure artificial airway, be able to clear secretions, and have no sustained dyspnea.
  4. Be adequately oxygenated at less than an FiO2 of 40%
  5. The patient must have stable ventilator settings with no need for “high tech” modes such as high frequency or inverse ratio ventilation.
  6. The patient must live within the geographic area serviced by the HME provider. The provider must be able to reach the patient’s home in less than two hours.
  7. Although the home setting is the least costly care venue for the ventilator dependent patient, adequacy of reimbursement must be assured before the discharge can take place.
  8. Home Assessment:
  • A visit to the patient’s home must take place early in the discharge process to assess the suitability and safety of the home environment.
  • The electrical service must be examined to ensure that the home can support the additional electrical requirements of the ventilator and any other medical equipment provided.
  • The space assigned to the ventilator-dependent patient must be adequate to arrange the equipment without interfering with emergency egress from the room.
  • There must be adequate storage for disposable supplies and adequate facilities to clean (hot and cold running water) and/or dispose of used items.
  • There must be a working telephone in the home in case of emergency.
  • The home must be assessed for cleanliness (infection control) and structural safety (no holes in the floor or roof, stairs in good repair).
  • The number of individuals living in the home must be taken into consideration.
  • There must be at least 2 primary caregivers willing to take responsibility for the ventilator-dependent patient’s care needs.