Introduction

A child with complex healthcare needs is considered to have one or more complex chronic condition, substantial healthcare needs, functional limitations, and significant healthcare usage [1]. A child dependent on medical technology requires a device or devices to provide a vital body function, and can include tracheostomies, invasive or non-invasive ventilation and oxygen [2]. There continues to be international inconsistences in the terminology used to describe children with complex healthcare needs, resulting in reported prevalence rates ranging from 0.2% − 11.4% [3].

Children with complex healthcare needs often experience prolonged hospital stays, with discharge delays frequently driven not only by clinical factors, such as unstable ventilation changes, acute episodes of illness, but also by contextual factors such as caregiver availability, social circumstances, housing challenges, and limited community resources [4–6]. A delay in discharge occurs when a patient is deemed medically fit to be discharged but due to operational or logistical issues, they remain in hospital [6,7]. International evidence highlights significant delays in the discharge of children with complex healthcare needs who are dependent on respiratory technology []. Across four US hospital centres, discharge delays were observed in 68.5% (n = 37) of children with the average length of stay of 53.9 days (range from 4–204 days) [4]. Most of these cases (n = 31) involved children with tracheostomy tubes. Evidence from the UK and Ireland demonstrates significant discharge delays for children with complex healthcare needs. In a UK tertiary centre, delays of over 3 months were noted in 50% (n = 8) of admissions [8], while an Irish study reported average hospitalisations of 8.7 months (range 3–22 months) despite medial stability [9].

Prolonged stays in hospital for children with long-term health problems are at a greater risk of development delays due to lack of age-appropriate stimulation and by lack of social interaction and gaining age-appropriate skills [5,10,11]. It can affect parent child attachment and bonding, and due to sleep disturbances in a busy acute setting, learning, memory, and emotional regulation patterns can be affected [10]. Delays in discharge has been identified as a health disparity due to the detrimental effect on their development [5] and it can impact the whole family, such as time off work and alternative childcare arrangements for siblings, significant travel to care centres [12].

Although discharge processes for children with medical complexity have been described in narrative or single-centre studies, no comprehensive synthesis of factors influencing discharge for respiratory technology-dependent children exists. The scoping review therefore aims to explore the current discharge process for children with complex healthcare needs who are dependent on respiratory technology. This review will provide the necessary foundation for future research aimed at developing a discharge pathway for children dependent on respiratory technology. This pathway seeks to minimize hospital stays and align with the national framework for children with complex healthcare needs.

Methods

This review will be conducted using the guidelines by Joanna Briggs Institute (JBI) methodology for scoping reviews [13] and will be reported using Preferred Reporting Items for Systematic review and Meta-Analysis – Scoping reviews (PRISMA-ScR) reporting guidelines [14]. The protocol is being reported according to the items of the Preferred reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist [15] (S1 File). The screening of records is scheduled for completion by November 2025, followed by data extraction by February 2026, will full completion of the scoping review expected by April 2026.

Ethical approval has not been sought for the present study because it is a review of published academic literature.

Study eligibility criteria

Eligibility criteria are presented in Table 1 using the population, concept and context framework [17].

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Table 1. Eligibility criteria for study selection organised by population, exposure and outcome (PEO).

https://doi.org/10.1371/journal.pone.0349670.t001

Discussion

This scoping review protocol outlines a comprehensive synthesis of peer-reviewed literature examining the initial hospital-to-home discharge process for children with complex healthcare needs who are dependent on respiratory technology, with the aim of identifying critical gaps, challenges, and opportunities for improvement. The factors identified through the review will be used for a proposed discharge pathway for children with complex healthcare needs dependent on respiratory technology.

One of the limitations of this review is the exclusion of grey literature and whilst there is grey literature published on this topic, the authors chose to focus this review on peer-reviewed sources. Four databases will be searched, which may result in articles in other databases or not correctly indexed articles being missed. A further limitation of this study is the inclusion only of English-language literature which may introduce geographical and linguistic bias.

Findings from this scoping review will be disseminated through peer-reviewed journal, national and international conferences, and both formal and informal teaching platforms to reach key stakeholders, policymakers, and clinicians. Findings from the scoping review will inform the next stage of research which will focus on the development of a discharge pathway. This will be undertaken in partnership with patient and public involvement stakeholders situated within the context of national policy priorities on integrated and delivering care closer to home.

Supporting information

Acknowledgments

No acknowledgements to disclose.