Abstract
Objective: To ensure safe care of mothers and babies after birth, irrespective of length of hospital stay, and to ensure effective links between hospital and community postnatal services.
Methods: Program aimed toward consumers and professionals working with them in Ottawa-Carleton (750,000 persons.) All pregnant women in the community included. Program developed by professionals, institutions and community agencies. Information on current practices elsewhere and early discharge literature studied. New provincial survey on practice changes performed in Ontario. Emergency room utilization data analyzed. Discharge and post-discharge criteria, and a common prenatal education curriculum, developed.
Results: Multidisciplinary, multi-sectoral committees, institutions and agencies have developed programs for appropriate discharge practice and improved postnatal follow-up. Professionals have supported flexible discharge guidelines.
Conclusions: Provided discharge criteria and follow-up are available, flexible discharge timing and safety appear compatible. The OttawaCarleton process to develop criteria and programs has allowed a collaborative, consensus-based approach to ‘early’ newborn discharge.
Résumé
Objectif: Garantir à la mère et à l’enfant des soins sécuritaires après la naissance, indépendamment de la durée du séjour à l’hôpital, et assurer de bons rapports entre l’hôpital et les services de soins postnatals de la collectivité.
Méthodes: Programme s’adressant aux consommateurs et aux professionnels qui s’en occupent dans la région d’Ottawa-Carleton (750 000 personnes). Inclusion de toutes les femmes enceintes dans la collectivité. Programme mis au point par des professionnels, des établissements et des organismes communautaires. Information relative aux pratiques courantes et étude de la littérature sur les sorties rapides de l’hôpital. Nouvelle enquête provinciale sur les changements aux pratiques en Ontario. Analyse des données relatives à l’utilisation de la salle d’urgence. Définition de critères de sortie et d’après-sortie, et mise au point d’un programme commun d’éducation prénatale.
Résultats: Mise au point de programmes sur les pratiques appropriées pour ce qui concerne les sorties de l’hôpital et sur l’amélioration du suivi postnatal. Appui des professionnels à des directives souples en matière de sorties.
Conclusions: À condition que suivi et critères de sortie soient disponibles, soins sécuritaires et souplesse au niveau des sorties sont compatibles. Le processus suivi dans la région d’Ottawa-Carleton pour définir des critères et mettre au point des programmes a permis d’adopter une approche de collaboration et de consensus en matière de sorties “rapides” des nouveau-nés.
References
- 1.Regan K. Early obstetrical discharge: A program that works. Canadian Nurse. 1984;80:32–35. [PubMed] [Google Scholar]
- 2.Braveman P, Egerter S, Pearl M, et al. Early discharge of newborns and mothers: A critical review of the literature. Pediatrics. 1995;96:716–26. [PubMed] [Google Scholar]
- 3.Margolis LH. A critical review of studies of newborn discharge timing. Clin Pediatr (Phila) 1995;34:626–34. doi: 10.1177/000992289503401201. [DOI] [PubMed] [Google Scholar]
- 4.Lee KS, Perlman M, Ballantyne M, et al. Association between duration of neonatal hospital stay and readmission rate. J Pediatr. 1995;127:758–66. doi: 10.1016/S0022-3476(95)70170-2. [DOI] [PubMed] [Google Scholar]
- 5.Keppler AB. Postpartum care center: Follow-up care in a hospital-based clinic. J Obstetric, Gynecologic, and Neonatal Nursing. 1995;24:17–21. doi: 10.1111/j.1552-6909.1995.tb02374.x. [DOI] [PubMed] [Google Scholar]
- 6.Bragg EJ, Rosenn BM, Siddiqi TA, Miodovnik M. The effect of early neonatal discharge on readmission rate in a tertiary medical center. Am J Obstet Gynecol. 1996;174:359. [Google Scholar]
- 7.Soskolne EI, Schumacher R, Fyock C, et al. The effect of early discharge and other factors on readmission rates of newborns. Arch Pediatr Adolesc Med. 1996;150:373–79. doi: 10.1001/archpedi.1996.02170290039006. [DOI] [PubMed] [Google Scholar]
- 8.Cooper WO, Kotagal UR, Atherton HD, et al. Use of health care services by inner-city infants in an early discharge program. Pediatrics. 1996;98:686–91. [PubMed] [Google Scholar]
- 9.Bragg EJ, Rosenn BM, Khoury JC, et al. The effect of early discharge after vaginal delivery on neonatal readmission rates. Obstet Gynecol. 1997;89:930–33. doi: 10.1016/S0029-7844(97)85764-X. [DOI] [PubMed] [Google Scholar]
- 10.Faucher D, McMillan D, Ohlsson A, et al. Facilitating discharge home following a normal term birth. Paediatr Child Health. 1996;1:165–68. [Google Scholar]
- 11.Perinatal Committee of Eastern OntarioWestern Quebec. Suggested criteria for discharge of mothers and babies from hospital after birth of a healthy fullterm infant. The Perinatal Newsletter (Perinatal Education Program of Eastern Ontario) 1996;13:3–4. [Google Scholar]
- 12.American Academy of Pediatrics Committee on FetusNewborn. Hospital stay for healthy term newborns. Pediatrics. 1995;96:788–90. [PubMed] [Google Scholar]