Facilitating discharge from hospital of the healthy term infant

Lemyre, Brigitte; Jefferies, Ann L; O’Flaherty, Pat

doi:10.1093/pch/pxy127

Cited by 21 publications

(24 citation statements)

References 56 publications

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“…25 Although the hospital length of stay for term singleton newborns delivered vaginally in Canada has decreased over time, 22,26 outside of the context of midwifery care, very early discharge is not supported by current Canadian guidelines or service delivery models (which do not typically provide in-home early postpartum care from a primary care provider). 24 As would be expected given the rates of very early discharge in our study, the rate of phototherapy before hospital discharge was lower than for nonmidwife-attended births in Ontario during the same time frame. 11 Rates of readmission for jaundice in our study were similar to previously reported rates for the rest of the Ontario population between 2003 and 2011.…”

Section: Discussionsupporting

confidence: 63%

“…Outside of the midwifery model of care, early discharge has been defined variously as discharge on the same day as birth or within 24-48 hours. [22][23][24] A 2012 survey of Canadian hospitals showed that the length of stay following vaginal birth decreased from 3.2 days in 1993 to 2.0 days in 2012. 25 Although the hospital length of stay for term singleton newborns delivered vaginally in Canada has decreased over time, 22,26 outside of the context of midwifery care, very early discharge is not supported by current Canadian guidelines or service delivery models (which do not typically provide in-home early postpartum care from a primary care provider).…”

Section: Discussionmentioning

confidence: 99%

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Trends in very early discharge from hospital for newborns under midwifery care in Ontario from 2003 to 2017: a retrospective cohort study

Darling

Babe

Sorbara

et al. 2020

cmajo

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Background: Very early discharge from hospital is an element of Ontario midwifery care. Our aim in the present study was to describe the frequency of very early hospital discharge for newborns in Ontario midwifery care over time. Methods:We conducted a retrospective population-based cohort study, including all midwife-attended singleton term cephalic newborns delivered by spontaneous vaginal birth at Ontario hospitals between April 2003 and February 2017. Our primary outcome was very early hospital discharge (< 6 h after birth) for newborns. Secondary outcomes were pediatric consultation before hospital discharge, phototherapy before hospital discharge and readmission for treatment of jaundice. We used generalized linear mixed models to estimate the relation between maternal, neonatal and hospital factors and very early discharge, while accounting for clustering by hospital. Results:The study cohort included 101 852 newborns born at 89 hospitals. Between 2003/04 and 2016/17, the unadjusted rate of very early discharge decreased from 34.3% to 30.7%. This trend was not significant after adjustment for covariates (odds ratio 1.0, 95% confidence interval 0.99-1.0). Unadjusted rates of pediatric consultation, phototherapy and readmission for jaundice all rose slightly over the study period. Hospital-specific risk-adjusted frequencies of very early discharge ranged from 5% (n = 1479) to 83% (n = 3459) across the 75 Ontario hospitals with at least 100 newborns included in the study cohort.Interpretation: Hospital-level factors contributed to the observed decrease in crude rates of very early discharge for midwifery clients. Wide variation in these rates across Ontario hospitals points to room for improvement to make more efficient use of health care resources by promoting optimal levels of very early discharge.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Trends in very early discharge from hospital for newborns under midwifery care in Ontario from 2003 to 2017: a retrospective cohort study

Darling

Babe

Sorbara

et al. 2020

cmajo

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“…Policy documents offered defintions of discharge readiness that mentioned assessment of physical or medical readiness for discharge, but acknowledged that confidence of the mother, social risk factors, support available at home and access to follow up care were also important [ 24 , 33 , 34 ]. Defnitions in research documents recognised that the decision to discharge was ‘complex’ and varied depending on the confidence of the mother to take care of the baby at home, support and stability at home, access to follow up care, social vulnerabilities and psychological adaptation [ 30 , 35 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…maternal serologies, infant metabolic screening, infant hearing screening, infant APGAR test) 8 [47%] [ 36 , 47 , 50 – 53 , 55 , 56 ] 7 [54%] [ 24 , 33 , 34 , 37 , 38 , 42 , 44 ] Treatment (e.g. newborn immunisations, infant HepB vaccine, ARVs for mother and baby if HIV+) 6 [35%] [ 32 , 35 , 36 , 51 , 52 , 56 ] 8 [62%] [ 24 , 33 , 34 , 37 , 38 , 42 – 44 ] Knowledge, ability and confidence regarding self-care and infant care 13 [76%] [ 11 , 12 , 25 , 31 , 35 , 36 , 47 – 53 ] 11 [85%] [ 24 , 33 , 34 , 37 – 40 , 42 – 45 ] Education (information provided to mother on various topics e.g. breastfeeding, care of newborn, car seat safety, family planning, hygiene practices) 3 [18%] [ 36 , 47 , 52 ] 10 [77%] [ …”

Section: Resultsmentioning

confidence: 99%

Discharge preparation and readiness after birth: a scoping review of global policies, guidelines and literature

Smith¹,

Harvey

Portela

2022

BMC Pregnancy Childbirth

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Background Despite the existence of global recommendations, postnatal care provided following childbirth is variable and often fails to address a woman’s concerns about herself and the parents’ concerns about their baby. Discharge from a facility after birth is a key moment to ensure the woman, parents and newborn receive support for the transition to care in the home. We mapped the current policies, guidance and literature on discharge preparation and readiness to identify key concepts and evidence and inform recommendations to be considered in a World Health Organization (WHO) guidance on postnatal care. Methods We were guided by the Johanna Briggs Institute approach, and developed inclusion criteria based on existing defintions of discharge preparation and readiness, and criteria for discharge readiness compiled by international professional organisaitons. To identify guidelines and policies we searched websites and archives of guideline organisations, and contacted individuals and professional societies working on postnatal care. We searched 14 electronic databases to locate published research and other literature on discharge preparation and readiness. For documents that met the inclusion criteria we extracted key characteristics, summarised discharge readiness criteria and components and discharge preparation steps, and characterised interventions to improve discharge preparation. Results The review provides a systematic map of criteria for discharge that are in use and the common steps healthcare providers take in preparing women and newborns for the transition home. The mapping also identified interventions used to strengthen discharge preparation, theories and models that conceptualise discharge preparation, scales for measuring discharge readiness and qualitative studies on the perspectives of women, men and healthcare providers on postnatal discharge. Conclusions The findings highlight contrasts between the research literature and policy documents. They indicate potential gaps in current discharge policies, and point to the need for more comprehensive discharge assessment and education to better identify and meet the needs of women, parents/caregivers and families prior to discharge and identify those who may require additional support. Protocol registration details The protocol for the review was registered with protocols.io on 23 November 2020: 10.17504/protocols.io.bpzymp7w

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“…Benitz and the Committee on Fetus and Newborn emphasised the need for an early post‐discharge visit, including weighing, and assessment of general health, hydration status and the degree of jaundice . The Canadian Paediatric Society has also emphasised newborn assessment 24‐72 hours after discharge, while Battersby et al in the UK suggest that newborns with risk factors may benefit from a community midwife visit around the 3rd day. Despite recommendations, few studies have reported on the implementation of early post‐discharge follow‐up …”

Section: Introductionmentioning

confidence: 99%

Post‐discharge neonatal hyperbilirubinemia surveillance

et al. 2019

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Aim To assess implementation of the Israel Neonatal Society's 2008 guidelines for universal community assessment of jaundice within 72 hours of discharge from birth hospitalisation. Methods Mothers of newborns were interviewed at Maternal Child Health Clinics in the Jerusalem District, Israel, and asked whether their newborn had been evaluated for jaundice within the recommended time frame. Newborn discharge letters from Israeli hospitals were assessed for appropriate inclusion of instructions for early follow‐up for jaundice. Results Out of 659, 217 (32.9%) mothers whose newborns were at low risk for neonatal hyperbilirubinemia reported an examination within 72 hours of discharge. Eighteen (8.3%) were referred for a bilirubin test. In contrast, 99.1% (109/110) of high‐risk newborns who were specifically invited for a bilirubin test the day following discharge complied. Out of 26, 12 (46.2%) hospital discharge letters specified both a time limit of 72 hours post‐discharge and jaundice as a reason for early follow‐up. Conclusion The early community surveillance rate for jaundice was low, contrasting with near universal compliance in those who received a specific instruction for a post‐discharge bilirubin blood test. Inclusion of specific written instructions in hospital discharge summaries was also low and may contribute to poor implementation of guidelines.

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Facilitating discharge from hospital of the healthy term infant

Abstract: All Canadian Paediatric Society position statements and practice points are reviewed regularly and revised as needed. Consult the Position Statements section of the CPS website www.cps.ca/en/documents for the most current version. Retired statements are removed from the website.

Cited by 21 publications

References 56 publications

Trends in very early discharge from hospital for newborns under midwifery care in Ontario from 2003 to 2017: a retrospective cohort study

Trends in very early discharge from hospital for newborns under midwifery care in Ontario from 2003 to 2017: a retrospective cohort study

Discharge preparation and readiness after birth: a scoping review of global policies, guidelines and literature

Post‐discharge neonatal hyperbilirubinemia surveillance

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