The Impact of COronaVIrus Disease of 2019 Pandemic on Home Health Nursing Availability in Pediatric Patients After Tracheostomy Placement.

Background: Children with tracheostomies require skilled medical care performed by trained caregivers or home health nursing (HHN). HHN services are often limited, resulting in increased caregiver responsibilities. We aim to evaluate HHN availability, healthcare utilization, and mortality in tracheostomy dependent children, pre and post-COVID-19 pandemic.

Methods: Retrospective chart review of pediatric patients who underwent tracheostomy between November 2017 and September 2023. The COVID-19 pandemic time point was defined as March 15, 2020. Demographic, clinical and outcome parameters were collected from the electronic medical record. The pre- and postpandemic trend of HHN hours were evaluated using correlation statistics.

Results: Both groups had similar surrogate markers of medical complexity. There was no difference in the mean number of approved HHN hours, but both the mean number of HHN hours/week staffed (90 h vs. 50, p = 0.001) and mean percentage of approved HHN hours staffed (63% vs. 41%, p = 0.011) were significantly lower in the post-COVID-19 cohort. The trend in the pre-COVID-19 group was not statistically significant (ρ = 0.087, p = 0.639); the trend in the post-COVID-19 group was negative (ρ = -0.380, p = 0.001).

Conclusions: Since the COVID-19 pandemic, there has been a decrease in both the number and percentage of HHN hours staffed with no change in the number of approved HHN hours. Additionally, there was a decrease in hospital encounters in the post-COVID-19 group compared to pre-COVID-19. By assessing workforce shifts, medical providers, caregivers, and policymakers can appropriately anticipate the impact on this vulnerable population.