Early postnatal hospital discharge: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
Citation bot (talk | contribs)
Bots
4,913,034 edits
m Removed URL that duplicated unique identifier. Removed accessdate with no specified URL. | You can use this bot yourself. Report bugs here.| Activated by User:Nemo bis | via #UCB_webform
added missing information
Line 22: Line 22:


There has been controversy over the practice<ref>{{cite journal|last=Britton|first=John R.|authorlink=|author2=Helen L. Britton MD|author3=Susan A. Beebe MD |year=1994|title=Early discharge of the term newborn: A continued dilemma|journal=Pediatrics|volume=94|issue=3|pages=291&ndash;295|id=|url=http://pediatrics.aappublications.org/cgi/content/abstract/94/3/291|accessdate=2009-07-04|quote=|pmid=8065852}}</ref><ref>{{cite journal|date=December 1995|last2=Meyer |first2=BA|title=To Stay or Not to Stay? That is the Question|journal=New England Journal of Medicine|volume=333|issue=24|pmid=7477203|pages=1635&ndash;1637|id=|quote=|doi=10.1056/NEJM199512143332412|last1=Parisi|first1=V. M.}}</ref><ref name=Dershewitz1995>{{cite journal|last=Dershewitz|first=Robert|authorlink=|author2=Marshall, Richard|date=October 1995|title=Controversies of early discharge of infants from the well-newborn nursery|journal=Current Opinion in Pediatrics|volume=7|issue=5|pages=494–501 |quote=|doi=10.1097/00008480-199510000-00003|pmid=8541948}}</ref> and its relationship with follow-up care, cost, and [[Maternal physiological changes in pregnancy|maternal]] and newborn health may be complex.<ref>{{cite journal|last=Marbella|first=Anne M.|authorlink=|author2=Veerappa K. Chetty|author3=Peter M. Layde |year=1988|title=Neonatal Hospital Lengths of Stay, Readmissions, and Charges|journal=Pediatrics|volume=101|issue=1|pages=32&ndash;36|id=|url=http://pediatrics.aappublications.org/cgi/content/abstract/101/1/32|accessdate=2009-07-04|quote=|doi=10.1542/peds.101.1.32|pmid=9417147}}</ref><ref>{{cite journal|last=Maisels|first=Jeffrey|authorlink=|author2=Elizabeth Kring|year=1997|title=Early Discharge From the Newborn Nursery---Effect on Scheduling of Follow-up Visits by Pediatricians |journal=Pediatrics|volume=100|issue=1|pages=72&ndash;74|id=|url=http://pediatrics.aappublications.org/cgi/content/abstract/100/1/72|accessdate=2009-07-04|quote=|doi=10.1542/peds.100.1.72|pmid=9200362}}</ref><ref>{{cite journal|last=Grupp-Phelan|first=Jacqueline|authorlink=|author2=James A. Taylor|author3=Lenna L. Liu|author4=Robert L. Davis |year=1999|title=Early Newborn Hospital Discharge and Readmission for Mild and Severe Jaundice |journal=Arch Pediatr Adolesc Med|volume=153|issue=12|pages=1283&ndash;1288|id=|quote=|pmid=10591307|doi=10.1001/archpedi.153.12.1283}}</ref> A 1995 review found that available studies were insufficient to shed much light on the consequences.<ref>{{cite journal|last=Braveman|first=Paula|authorlink=|author2=Susan Egerter|author3=Michelle Pearl|author4=Kristen Marchi|author5=Carol Miller |year=1995|title=Early Discharge of Newborns and Mothers: A Critical Review of the Literature|journal=Pediatrics|volume=96|issue=4|pages=716&ndash;726|id=|url=http://pediatrics.aappublications.org/cgi/content/abstract/96/4/716|accessdate=2009-07-04|quote=|pmid=7567337}}</ref> A study concluded that early discharge is safe if it is part of a program involving postnatal care outside the hospital.<ref name=Dershewitz1995/>
There has been controversy over the practice<ref>{{cite journal|last=Britton|first=John R.|authorlink=|author2=Helen L. Britton MD|author3=Susan A. Beebe MD |year=1994|title=Early discharge of the term newborn: A continued dilemma|journal=Pediatrics|volume=94|issue=3|pages=291&ndash;295|id=|url=http://pediatrics.aappublications.org/cgi/content/abstract/94/3/291|accessdate=2009-07-04|quote=|pmid=8065852}}</ref><ref>{{cite journal|date=December 1995|last2=Meyer |first2=BA|title=To Stay or Not to Stay? That is the Question|journal=New England Journal of Medicine|volume=333|issue=24|pmid=7477203|pages=1635&ndash;1637|id=|quote=|doi=10.1056/NEJM199512143332412|last1=Parisi|first1=V. M.}}</ref><ref name=Dershewitz1995>{{cite journal|last=Dershewitz|first=Robert|authorlink=|author2=Marshall, Richard|date=October 1995|title=Controversies of early discharge of infants from the well-newborn nursery|journal=Current Opinion in Pediatrics|volume=7|issue=5|pages=494–501 |quote=|doi=10.1097/00008480-199510000-00003|pmid=8541948}}</ref> and its relationship with follow-up care, cost, and [[Maternal physiological changes in pregnancy|maternal]] and newborn health may be complex.<ref>{{cite journal|last=Marbella|first=Anne M.|authorlink=|author2=Veerappa K. Chetty|author3=Peter M. Layde |year=1988|title=Neonatal Hospital Lengths of Stay, Readmissions, and Charges|journal=Pediatrics|volume=101|issue=1|pages=32&ndash;36|id=|url=http://pediatrics.aappublications.org/cgi/content/abstract/101/1/32|accessdate=2009-07-04|quote=|doi=10.1542/peds.101.1.32|pmid=9417147}}</ref><ref>{{cite journal|last=Maisels|first=Jeffrey|authorlink=|author2=Elizabeth Kring|year=1997|title=Early Discharge From the Newborn Nursery---Effect on Scheduling of Follow-up Visits by Pediatricians |journal=Pediatrics|volume=100|issue=1|pages=72&ndash;74|id=|url=http://pediatrics.aappublications.org/cgi/content/abstract/100/1/72|accessdate=2009-07-04|quote=|doi=10.1542/peds.100.1.72|pmid=9200362}}</ref><ref>{{cite journal|last=Grupp-Phelan|first=Jacqueline|authorlink=|author2=James A. Taylor|author3=Lenna L. Liu|author4=Robert L. Davis |year=1999|title=Early Newborn Hospital Discharge and Readmission for Mild and Severe Jaundice |journal=Arch Pediatr Adolesc Med|volume=153|issue=12|pages=1283&ndash;1288|id=|quote=|pmid=10591307|doi=10.1001/archpedi.153.12.1283}}</ref> A 1995 review found that available studies were insufficient to shed much light on the consequences.<ref>{{cite journal|last=Braveman|first=Paula|authorlink=|author2=Susan Egerter|author3=Michelle Pearl|author4=Kristen Marchi|author5=Carol Miller |year=1995|title=Early Discharge of Newborns and Mothers: A Critical Review of the Literature|journal=Pediatrics|volume=96|issue=4|pages=716&ndash;726|id=|url=http://pediatrics.aappublications.org/cgi/content/abstract/96/4/716|accessdate=2009-07-04|quote=|pmid=7567337}}</ref> A study concluded that early discharge is safe if it is part of a program involving postnatal care outside the hospital.<ref name=Dershewitz1995/>

== Content ==

* U.K.
* Controversy
* Preparedness

==== U.K. ====
One study done by John Bowers and Helen Cheyne in the U.K. investigated if reducing the length of the patients stay could be possible and safe.<ref>{{Cite journal|last=Bowers|first=John|last2=Cheyne|first2=Helen|date=2016-01-15|title=Reducing the length of postnatal hospital stay: implications for cost and quality of care|url=https://doi.org/10.1186/s12913-015-1214-4|journal=BMC Health Services Research|volume=16|issue=1|pages=16|doi=10.1186/s12913-015-1214-4|issn=1472-6963|pmc=PMC4714454|pmid=26772389}}</ref> In the U.K. having a baby is the number one reason for hospital visits, with 800,000 babies being born annually. These numbers are costing the NHS (National Health Service) 2.5 billion pounds per year. They considered making the stay shorter due to the amount of women who use midwives and have access to postnatal care, without hospital involvement. Their study found that while they could reduce the postnatal stay without jeopardizing the patients it would not save the hospitals enough money to make the reduction worthwhile.

==== Controversy ====
A study done by Rawad Farhat and Rajab Marium was done to compare early discharge versus late discharge with the risk of readmission.<ref>{{Cite journal|last=Farhat|first=Rawad|last2=Rajab|first2=Mariam|date=2011-03-01|title=Length of postnatal hospital stay in healthy newborns and re-hospitalization following early discharge|url=http://www.najms.org/article.asp?issn=1947-2714;year=2011;volume=3;issue=3;spage=146;epage=151;aulast=Farhat;type=0|journal=North American Journal of Medical Sciences|language=en|volume=3|issue=3|pages=146|issn=1947-2714}}</ref>  Some proponents of early hospital discharge claim that it is safe, decreases the risk of iatrogenic infection, promotes family bonding and attachment, and reduces hospitalization care and patient costs. While some disadvantages include delayed breastfeeding, manifestation of new conditions affecting newborns after early discharge, and improper discharge planning. A total of 478 babies were enrolled, of which 307 were discharged in 48 hours or less. Thirty-eight (7.9%) newborns were re-hospitalized, with the most common cause being neonatal jaundice. Based on their finding they concluded that hospital discharge at any time in 48 hours or less significantly increases the risk for readmission as well as the risk for readmission due to hyperbilirubinemia (an excess of Bilirubin in the blood). Planning and implementing a structured program for follow up of infants who are discharged in 48 hours or less are vital in order to decrease the risk for readmission, morbidity and neonatal mortality.

In another study done by Kay M. Tomashek et. al., they researched the rate of infant morbidity in late preterm and term infants and their discharge time.<ref>{{Cite journal|last=Tomashek|first=Kay M.|last2=Shapiro-Mendoza|first2=Carrie K.|last3=Weiss|first3=Judith|last4=Kotelchuck|first4=Milton|last5=Barfield|first5=Wanda|last6=Evans|first6=Stephen|last7=Naninni|first7=Angela|last8=Declercq|first8=Eugene|date=2006-04-01|title=Early Discharge Among Late Preterm and Term Newborns and Risk of Neonatal Morbidity|url=http://www.sciencedirect.com/science/article/pii/S0146000506000292|journal=Seminars in Perinatology|series=Optimizing Care and Outcomes for Late Preterm (Near-Term) Infants: Part 2|language=en|volume=30|issue=2|pages=61–68|doi=10.1053/j.semperi.2006.02.003|issn=0146-0005}}</ref> Of the 1004 late preterm and 24,320 term infants in our study, 4.3% and 2.7% of infants, respectively, were either readmitted or had an observational stay. Late preterm infants were 1.5 times more likely to require hospital-related care and 1.8 times more likely to be readmitted than term infants. Among infants who were breastfed, late preterm infants were 1.8 times more likely than term infants to require hospital-related care and 2.2 times more likely to be readmitted. Jaundice and infection accounted for the majority of readmission's. Their findings suggest that late preterm infants discharged early experience significantly more neonatal morbidity than term infants discharged early; however, this may be true only for breastfed infants.

==== Preparedness ====
In a study done by Gabriella Malagon-Maldonado et. al., They were researching the antepartum, intrapartum, and postpartum predictors of discharge readiness, including nursing educational practices that are predictive of postpartum mothers' perceptions of readiness for hospital discharge.<ref>{{Cite journal|last=Malagon-Maldonado|first=Gabriella|last2=Connelly|first2=Cynthia D.|last3=Bush|first3=Ruth A.|date=2017-04|title=Predictors of Readiness for Hospital Discharge After Birth: Building Evidence for Practice|url=https://www.ncbi.nlm.nih.gov/pubmed/28226190|journal=Worldviews on Evidence-Based Nursing|volume=14|issue=2|pages=118–127|doi=10.1111/wvn.12208|issn=1741-6787|pmid=28226190}}</ref> Their results found that M\mothers with three or more children, delivery mode, bottle-feeding, the delivery of education, and the difference between educational content received and needed, were significant predictors that accounted for 42% of the variance in readiness for hospital discharge. Nurses' skill in teaching and educational content received were significant predictors even with parity, feeding, and delivery mode in the model.


==References==
==References==

Revision as of 18:30, 23 March 2020

Early postnatal hospital discharge is typically defined as the discharge of the mother and newborn from the hospital within 48 hours of birth.

The length of stay in a hospital after childbirth decreased gradually[clarification needed] over several decades[clarification needed] in the U.S., initially because of consumer desire for a less medical interventions related to childbirth, and later in an effort to reduce costs.[1] A similar gradual shortening of postnatal hospital stays occurred in Canada.[2] Early discharge has also occurred in the U.K.[3] and Australia.[4]

There has been controversy over the practice[5][6][7] and its relationship with follow-up care, cost, and maternal and newborn health may be complex.[8][9][10] A 1995 review found that available studies were insufficient to shed much light on the consequences.[11] A study concluded that early discharge is safe if it is part of a program involving postnatal care outside the hospital.[7]

Content

  • U.K.
  • Controversy
  • Preparedness

U.K.

One study done by John Bowers and Helen Cheyne in the U.K. investigated if reducing the length of the patients stay could be possible and safe.[12] In the U.K. having a baby is the number one reason for hospital visits, with 800,000 babies being born annually. These numbers are costing the NHS (National Health Service) 2.5 billion pounds per year. They considered making the stay shorter due to the amount of women who use midwives and have access to postnatal care, without hospital involvement. Their study found that while they could reduce the postnatal stay without jeopardizing the patients it would not save the hospitals enough money to make the reduction worthwhile.

Controversy

A study done by Rawad Farhat and Rajab Marium was done to compare early discharge versus late discharge with the risk of readmission.[13]  Some proponents of early hospital discharge claim that it is safe, decreases the risk of iatrogenic infection, promotes family bonding and attachment, and reduces hospitalization care and patient costs. While some disadvantages include delayed breastfeeding, manifestation of new conditions affecting newborns after early discharge, and improper discharge planning. A total of 478 babies were enrolled, of which 307 were discharged in 48 hours or less. Thirty-eight (7.9%) newborns were re-hospitalized, with the most common cause being neonatal jaundice. Based on their finding they concluded that hospital discharge at any time in 48 hours or less significantly increases the risk for readmission as well as the risk for readmission due to hyperbilirubinemia (an excess of Bilirubin in the blood). Planning and implementing a structured program for follow up of infants who are discharged in 48 hours or less are vital in order to decrease the risk for readmission, morbidity and neonatal mortality.

In another study done by Kay M. Tomashek et. al., they researched the rate of infant morbidity in late preterm and term infants and their discharge time.[14] Of the 1004 late preterm and 24,320 term infants in our study, 4.3% and 2.7% of infants, respectively, were either readmitted or had an observational stay. Late preterm infants were 1.5 times more likely to require hospital-related care and 1.8 times more likely to be readmitted than term infants. Among infants who were breastfed, late preterm infants were 1.8 times more likely than term infants to require hospital-related care and 2.2 times more likely to be readmitted. Jaundice and infection accounted for the majority of readmission's. Their findings suggest that late preterm infants discharged early experience significantly more neonatal morbidity than term infants discharged early; however, this may be true only for breastfed infants.

Preparedness

In a study done by Gabriella Malagon-Maldonado et. al., They were researching the antepartum, intrapartum, and postpartum predictors of discharge readiness, including nursing educational practices that are predictive of postpartum mothers' perceptions of readiness for hospital discharge.[15] Their results found that M\mothers with three or more children, delivery mode, bottle-feeding, the delivery of education, and the difference between educational content received and needed, were significant predictors that accounted for 42% of the variance in readiness for hospital discharge. Nurses' skill in teaching and educational content received were significant predictors even with parity, feeding, and delivery mode in the model.

References

  1. ^ (Commentary), A. P. (February 2001). "Early Postpartum Discharge: Recommendations From a Preliminary Report to Congress". Pediatrics. 107 (2): 400–403. doi:10.1542/peds.107.2.400. PMID 11158474. Retrieved 2009-07-04.
  2. ^ Society of Obstetricians and Gynaecologists of Canada (April 2007). "Postpartum maternal and newborn discharge" (PDF). SOGC Policy Statement (190). Archived from the original (PDF) on 2009-01-24. Retrieved 2009-07-04. The length of stay in hospital postpartum has been steadily decreasing over the last 50 years.
  3. ^ Oddie, S.J.; D Hammal; S Richmond; L Parker (2005). "Early discharge and readmission to hospital in the first month of life in the Northern Region of the UK during 1998: a case cohort study". Archives of Disease in Childhood. 90 (2): 119–124. doi:10.1136/adc.2003.040766. PMC 1720274. PMID 15665161. Retrieved 2009-07-04.
  4. ^ Hickey, Anthea R.; Philip M Boyce; David Ellwood; Allen D Morris-Yates (1997). "Early discharge and risk for postnatal depression". Medical Journal of Australia. 167 (5): 244–247. doi:10.5694/j.1326-5377.1997.tb125047.x. Archived from the original on 2009-06-23.
  5. ^ Britton, John R.; Helen L. Britton MD; Susan A. Beebe MD (1994). "Early discharge of the term newborn: A continued dilemma". Pediatrics. 94 (3): 291–295. PMID 8065852. Retrieved 2009-07-04.
  6. ^ Parisi, V. M.; Meyer, BA (December 1995). "To Stay or Not to Stay? That is the Question". New England Journal of Medicine. 333 (24): 1635–1637. doi:10.1056/NEJM199512143332412. PMID 7477203.
  7. ^ a b Dershewitz, Robert; Marshall, Richard (October 1995). "Controversies of early discharge of infants from the well-newborn nursery". Current Opinion in Pediatrics. 7 (5): 494–501. doi:10.1097/00008480-199510000-00003. PMID 8541948.
  8. ^ Marbella, Anne M.; Veerappa K. Chetty; Peter M. Layde (1988). "Neonatal Hospital Lengths of Stay, Readmissions, and Charges". Pediatrics. 101 (1): 32–36. doi:10.1542/peds.101.1.32. PMID 9417147. Retrieved 2009-07-04.
  9. ^ Maisels, Jeffrey; Elizabeth Kring (1997). "Early Discharge From the Newborn Nursery---Effect on Scheduling of Follow-up Visits by Pediatricians". Pediatrics. 100 (1): 72–74. doi:10.1542/peds.100.1.72. PMID 9200362. Retrieved 2009-07-04.
  10. ^ Grupp-Phelan, Jacqueline; James A. Taylor; Lenna L. Liu; Robert L. Davis (1999). "Early Newborn Hospital Discharge and Readmission for Mild and Severe Jaundice". Arch Pediatr Adolesc Med. 153 (12): 1283–1288. doi:10.1001/archpedi.153.12.1283. PMID 10591307.
  11. ^ Braveman, Paula; Susan Egerter; Michelle Pearl; Kristen Marchi; Carol Miller (1995). "Early Discharge of Newborns and Mothers: A Critical Review of the Literature". Pediatrics. 96 (4): 716–726. PMID 7567337. Retrieved 2009-07-04.
  12. ^ Bowers, John; Cheyne, Helen (2016-01-15). "Reducing the length of postnatal hospital stay: implications for cost and quality of care". BMC Health Services Research. 16 (1): 16. doi:10.1186/s12913-015-1214-4. ISSN 1472-6963. PMC 4714454. PMID 26772389.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  13. ^ Farhat, Rawad; Rajab, Mariam (2011-03-01). "Length of postnatal hospital stay in healthy newborns and re-hospitalization following early discharge". North American Journal of Medical Sciences. 3 (3): 146. ISSN 1947-2714.
  14. ^ Tomashek, Kay M.; Shapiro-Mendoza, Carrie K.; Weiss, Judith; Kotelchuck, Milton; Barfield, Wanda; Evans, Stephen; Naninni, Angela; Declercq, Eugene (2006-04-01). "Early Discharge Among Late Preterm and Term Newborns and Risk of Neonatal Morbidity". Seminars in Perinatology. Optimizing Care and Outcomes for Late Preterm (Near-Term) Infants: Part 2. 30 (2): 61–68. doi:10.1053/j.semperi.2006.02.003. ISSN 0146-0005.
  15. ^ Malagon-Maldonado, Gabriella; Connelly, Cynthia D.; Bush, Ruth A. (2017-04). "Predictors of Readiness for Hospital Discharge After Birth: Building Evidence for Practice". Worldviews on Evidence-Based Nursing. 14 (2): 118–127. doi:10.1111/wvn.12208. ISSN 1741-6787. PMID 28226190. {{cite journal}}: Check date values in: |date= (help)


Stub icon

This hospital-related article is a stub. You can help Wikipedia by expanding it.

Stub icon

This human reproduction article is a stub. You can help Wikipedia by expanding it.

Retrieved from "https://en.wikipedia.org/w/index.php?title=Early_postnatal_hospital_discharge&oldid=947005096"