P0089 - Delays in Hospital Discharge for Children in Foster Care: Reasons and Recommendations from a Multisite Study

Background: The American Academy of Pediatrics classifies all children in foster care as children with special health care needs based on their high prevalence of health problems and unmet healthcare needs. As such, these children interact frequently with the healthcare system, including the inpatient hospital setting. Caring for children in foster care poses unique challenges to the hospital system and providers, including delays in discharge. Yet, little is known about drivers of delayed discharge or potential solutions. The objective of this study was to identify barriers and solutions to timely hospital discharge for children in foster care.

Methods: We recruited inpatient, pediatric providers from pediatric hospitals within the mid-Atlantic region with prior experience caring for children in foster care. Semi-structured interviews were conducted to explore the provider experience in discharging children to foster care. Conventional content analysis was applied to interview transcripts with Dedoose software. Thematic saturation was achieved.

Results: We interviewed 38 providers from 6 hospitals; 14 physicians, 11 RNs, 10 social workers, 2 case managers, and 1 nurse practitioner. Delays in discharge were considered the norm for children in foster care, “Every new foster care placement, the discharge is delayed, every one, whether it's a day, whether it's five days… I've had those kids stay for a week, awaiting foster care placement.” Participants identified many factors that contribute to delayed discharges, including time intensive and meticulous discharge planning, reliance on hospital social workers to facilitate discharge, legal and child welfare procedural delays, and lack of available foster care placements. Some identified solutions included standardizing discharge procedures, proactive discharge planning among multidisciplinary team members, and enhancing hospital providers’ ability to address the unique discharge needs of children in foster care. Themes and subthemes that emerged from the data are presented with illustrative quotations, representing participant identified reasons for delayed discharge (Table 1) and recommendations for improvement (Table 2).

Conclusion: Delayed discharge for children in foster care is multifactorial, yet often predictable. There are modifiable factors identified that can be addressed to promote timely hospital discharge and prevent medically unnecessary hospital days, benefitting patients in foster care and the hospital system.