Alyssa Reese BA BS, Medical Student, University at Buffalo’s Jacobs School of

Medicine and Biomedical Sciences, adreese@buffalo.edu

Brandon Mariotti MD, Resident Physician, University at Buffalo’s Jacobs School of

Medicine and Biomedical Sciences, blmariot@buffalo.edu

Michael DiGiacomo MD, Associate Director of Medical Education and Clinical Assistant
Professor, Department of Psychiatry, University at Buffalo’s Jacobs School of Medicine
and Biomedical Sciences, mrd7@buffalo.edu

A Critical Analysis of Policy Strategies for Safe and Timely Pediatric Hospital
Discharges

Introduction
Healthcare facilities across the United States have seen a notable increase in the
number of children with complex barriers to discharge, particularly in the inpatient
psychiatric setting. This has resulted in prolonged “administratively necessary” hospital
stays, predominantly stemming from a scarcity of placements at long-term residential
centers and treatment programs. Adding to the complexity, some children are
abandoned by their parent/guardian, resulting in a referral to Child Protective Services
(CPS). This study seeks to provide a critical analysis of historical and proposed
national, state, and hospital policy strategies aimed at enhancing the safety and
expediency of pediatric hospital discharges.

Methods
A comprehensive literature review was performed through use of medical and policy
databases, including PubMed, PsycINFO, Westlaw Campus Research, HeinOnline, and
ProQuest Congressional. No limitation was placed on article publication date. Inclusion
criteria were broad and encompassed medical studies, policy documents, and legal
articles that addressed pediatric hospital discharges and child abandonment at
healthcare facilities.

Results
This comprehensive policy analysis revealed multifaceted insights into the challenges
surrounding pediatric hospital discharges. Children at risk for extended hospital stays
are primarily those with complex medical conditions, intricate behavioral needs, or
affiliation with the child welfare system. Notably, the act of a parent or guardian to
refrain from reclaiming custody of a child who is currently in a healthcare facility, often
stemming from an inability to meet the child’s medical or behavioral health needs, does
not often align with the legal definition of child abandonment. Policy strategies were
most often state-based and focused on behavioral health reform and systemic child
welfare interventions. Examples included the 2023 House Bill 1580, a child welfare bill
approved in the state of Washington, and the North Carolina Integrated Care for Kids
program, designed to improve coordination of care and reduce administratively
necessary hospital stays.

Conclusion
The results of this critical analysis of current legislation underscore the complexity of
pediatric hospital discharges. Despite facing comparable challenges, state legislative
variations indicate potential areas for standardization and improvement. State policies
could lead the way in addressing this issue through expanded implementation on a
national level. Future qualitative research is planned to gain insights into key
stakeholder opinions on extended stays of pediatric patients in healthcare. Additionally,
quantitative data will be collected to assess common reasons for extended stays in the
inpatient pediatric psychiatric facility at the Erie County Medical Center in Buffalo, New
York.