Medically dependent severe motor and intellectual disabilities: Time study of medical care.
BACKGROUND
Improvements in neonatal medicine and pediatric emergency medicine have led to an increasing number of children with severe disabilities requiring medical care, such as tracheal suction, on a daily basis. Most of these children, discharged directly from hospitals to their parents' homes, need home medical support. To provide data for the establishment of appropriate support systems, we analyzed the care for such children in a time study conducted at an institution.


METHODS
A minute-by-minute time study of the work of 33 staff members in a ward for patients (medically dependent severe motor and intellectual disabilities [SMID]) requiring frequent medical care was carried out over 48 h. Data were compared with those from a ward for ordinary non-medically dependent SMID patients.


RESULTS
Time of life care for medically dependent SMID and ordinary SMID was almost identical, but the time for medical care for the former was 10-fold longer than that of the latter. Also, tasks involving information exchange and recording of the time of care were performed fourfold more frequently in the medically dependent SMID than in the ordinary SMID ward.


CONCLUSIONS
Medically dependent SMID children and adults, predominantly with tracheostomies, needed much more medical care and more concentrated involvement of the staff compared with ordinary SMID. This study provides valuable data for the development of support systems for medically dependent SMID children being cared for at home. In addition, it sheds light on the situation faced by non-SMID children requiring frequent medical care.
Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan.|Kumamoto-Ashikita Institution for Developmental Disabilities, Kumamoto, Japan.
Tadashi
T
Matsubasa
Department of Neonatology, Kumamoto University Hospital, Kumamoto, Japan.
Hiroshi
H
Mitsubuchi
Kumamoto-Ashikita Institution for Developmental Disabilities, Kumamoto, Japan.
Akihiko
A
Kimura
Kumamoto-Ashikita Institution for Developmental Disabilities, Kumamoto, Japan.
Makoto
M
Shinohara
Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Fumio
F
Endo
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006699:Home Care Services; D006801:Humans; D008607:Intellectual Disability / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D000068079:Motor Disorders / Q000628:therapy*; D020380:Needs Assessment; D005791:Patient Care / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities; D013997:Time Factors; D013996:Time and Motion Studies; D055815:Young Adult
home health care; medical care; severe motor and intellectual disabilities