Discharge Criteria
ÎPatients are eligible for discharge when they have documented overall clinical improvement, including level of activity, appetite, and decreased fever for at least 12-24 hours. (SR-VL)
ÎPatients are eligible for discharge when they demonstrate consistent measurements by pulse-oximetry that are > 90% in room air for at least 12-24 hours. (SR-M)
ÎPatients are eligible for discharge only if they demonstrate stable and/or baseline mental status. (SR-VL)
ÎPatients are not eligible for discharge if they have substantially increased work of breathing, sustained tachypnea or tachycardia. (SR-H)
ÎPatients should have documentation that they can tolerate their home anti-infective regimen, whether oral or intravenous, and home oxygen regimen if applicable, prior to hospital discharge. (SR-L)
ÎFor infants or young children requiring outpatient oral antibiotic therapy, clinicians should demonstrate that parents are able to administer and children are able to adequately comply with taking those antibiotics prior to discharge. (WR-VL)
ÎFor children who have had a chest tube and meet the requirements listed above, hospital discharge is appropriate after the chest tube has been removed for 12-24 hours, having either no clinical evidence of deterioration since removal or, if obtained for clinical concerns, chest radiograph evidence of no significant reaccumulation of a parapneumonic effusion or pneumothorax. (SR-VL)
ÎInfants and children with barriers to care including concern about careful observation at home, those who are unable to comply with therapy, and those unable to follow-up should have these issues identified and addressed prior to discharge. (WR-VL)
Indications for Parenteral Outpatient Therapy
ÎOutpatient parenteral antibiotic therapy should be offered to families of children no longer requiring skilled nursing care in an acute care facility but having a demonstrated need for ongoing parenteral therapy. (WR-M)
ÎOutpatient parenteral antibiotic therapy should be offered through a skilled pediatric home nursing program or through daily intramuscular injections at an appropriate pediatric outpatient facility. (WR-L)
ÎConversion to oral outpatient step-down therapy is preferred, when possible, to parenteral outpatient therapy. (SR-L)
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