Reduction of hospital stay at maternity unit: an evaluation of the impact on maternal and neonatal readmission

Society for Maternal-Fetal Medicine Special Statement: A critique of postpartum readmission rate as a quality metric

“…Some studies have found that longer lengths of stay are associated with lower postpartum readmission rates, 30,45 but others have found no such association. 42,60,71 Moreover, even if increasing the average length of stay by 1 day reduced the postpartum readmission rate from 2% to 0%, this would probably not be costeffective because 100 additional inpatient days during the birth hospitalization would be needed to prevent 2 postpartum readmissions.…”

Effects of a Midwife-Coordinated Maternity Care Intervention (ChroPreg) vs. Standard Care in Pregnant Women with Chronic Medical Conditions: Results from a Randomized Controlled Trial

“…During the study period, women in both groups reduced the median LOS by 0.9 days compared to the data initially used to calculate the sample size. Therefore, it may not have been possible or even advisable to reduce LOS further, as a further reduction might potentially negatively impact neonatal readmissions [33], breastfeeding rates, and patient experience [47]. A substantial part of the explanation for the overall reduction of LOS may be ascribed to recent local organizational changes at the study site (December 2019), where all women with uncomplicated deliveries were routinely discharged shortly after birth for outpatient postpartum care [48].…”

“…Data for this outcome were collected from electronic medical records. LOS is widely used as an objective health utilization outcome in health care research [33,34]. In this study, a potential reduction in LOS encompassed two critical issues: the patient perspective with a reduced need for hospitalization and the health economic aspect with a possible reduction of costs [34].…”

Early discharge from maternity ward in response to the COVID-19 pandemic: Impact on emergency attendance

“…In 2017, the median length of stay in a maternity ward was 3.9 days in France, 1.4 days in the United Kingdom, 1.5 days in Canada, 2 days in the United States, and 2.3 days in Sweden [2] . Worldwide, the length of stay in a maternity unit has tended to decrease over the past 10 years [3] . In 2014, the guidelines issued by French National Authority for Health ( Haute Autorité de Santé , HAS) defined early postpartum discharge as a hospital stay of between 48 and 72 h after a vaginal delivery and between 72 and 96 h after a cesarean delivery [4] .…”

“…In response to the first wave of the COVID-19 epidemic in France (from March to May 2020), our maternity hospital (part of Amiens University Medical Center, Amiens, France) rapidly implemented an early discharge plan for all eligible women (as defined by the HAS guidelines). However, some experts have suggested that early discharge is associated with a greater likelihood of subsequent emergency department visits [12] , a higher hospital readmission rate for the newborn [3] , and a risk of severe jaundice [13] . Furthermore, a lack of follow-up after hospital discharge can be associated with breastfeeding difficulties [14] and consequently early cessation of exclusive breastfeeding [14] or more frequent emergency department visits [15] .…”