Does family-centred neonatal discharge planning reduce healthcare usage? A before and after study in South West England

Abstract

ObjectiveTo implement parent-oriented discharge planning (Train-to-Home) for preterm infants in neonatal care.DesignBefore and after study, investigating the effects of the intervention during two 11-month periods before and after implementation.SettingFour local neonatal units (LNUs) in South West England.ParticipantsInfants without major anomalies born at 27–33 weeks’ gestation admitted to participating units, and their parents.Train-to-Home interventionA family-centred discharge package to increase parents’ involvement and understanding of their baby's needs, comprising a train graphic and supporting care pathways to facilitate parents’ understanding of their baby's progress and physiological maturation, combined with improved estimation of the likely discharge date.Main outcome measuresPerceived Maternal Parenting Self-Efficacy (PMP S-E) scores, infant length of stay (LOS) and healthcare utilisation for 8 weeks following discharge.ResultsParents reported that the Train-to-Home improved understanding of their baby's progress and their preparedness for discharge. Despite a lack of change in PMP S-E scores with the intervention, the number of post-discharge visits to emergency departments (EDs) fell from 31 to 20 (p<0.05), with a significant reduction in associated healthcare costs (£3400 to £2200; p<0.05) after discharge. In both study phases, over 50% of infants went home more than 3 weeks before their estimated date of delivery (EDD), though no reduction in LOS occurred.ConclusionsDespite the lack of measurable effect on the parental self-efficacy scores, the reduction in ED attendances and associated costs supports the potential value of this approach.

“Giving us hope”: Parent and neonatal staff views and expectations of a planned family‐centred discharge process (Train‐to‐Home)

“…Train‐to‐Home was introduced, and the baby's train was displayed on the cot with coloured stickers (red‐yellow‐green) indicating the stage of preparedness for discharge home (see Figure ) . Designed to be kept up‐to‐date by parents in discussion with staff, it aimed to improve parental confidence via engagement and education.…”

“…To minimize this, staff‐parent interactions must be improved and mothers’ and fathers’ opportunities to be main caregivers facilitated . Our study implemented a family‐centred care package, and where staff adopted it, changes in parental confidence in caring for their baby were seen when they left the NNU and particularly in the following weeks …”

“…Train‐to‐Home was introduced in four local neonatal units (LNUs) across South West England in 2013. A previous paper reports the wider study findings; we present here qualitative data comparing parental and neonatal staff perceptions and experiences of using Train‐to‐Home.…”

Experiences of Mothers of Extremely Preterm Infants after Hospital Discharge

“…Consistent with our findings, the loss of "the ideal child" can aggravate the residual guilt that mothers feel (Boykova, 2016), generating attitudes of overprotection or obsessive monitoring of the child's psychomotor development (González-Serrano et al, 2012). A parent-oriented discharge plan for preterm infants in neonatal care reduces the risk of readmission (Ingram et al, 2016), and early discharge home care programs (home supervision by a neonatal nurse) reduce anxiety and stress levels, increasing confidence and reassurance in one's abilities as a mother (Toral-López et al, 2016). While these measures are considered positive, they are not sufficient (Dellenmark-Blom & Wigert, 2014), and thus, mothers demand more social support and specialized healthcare professionals (Franck, McNulty & Alderdice, 2017).…”

Estimating discharge dates using routinely collected data: improving the preparedness of parents of preterm infants for discharge home

“…5 This study required that we estimate as accurately as possible, early in the hospital stay, the likely date of discharge for participating infants.…”