The effect of early postnatal discharge from hospital for women and infants: a systematic review protocol

Abstract

BackgroundThe length of postnatal hospital stay has declined over the last 40 years. There is little evidence to support a policy of early discharge following birth, and there is some concern about whether early discharge of mothers and babies is safe. The Cochrane review on the effects of early discharge from hospital only included randomised controlled trials (RCTs) which are problematic in this area, and a systematic review including other study designs is required. The aim of this broader systematic review is to determine possible effects of a policy of early postnatal discharge on important maternal and infant health-related outcomes.Methods/designA systematic search of published literature will be conducted for randomised controlled trials, non-randomised controlled trials (NRCTs), controlled before-after studies (CBA), and interrupted time series studies (ITS) that report on the effect of a policy of early postnatal discharge from hospital. Databases including Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and Science Citation Index will be searched for relevant material. Reference lists of articles will also be searched in addition to searches to identify grey literature. Screening of identified articles and data extraction will be conducted in duplicate and independently. Methodological quality of the included studies will be assessed using the Effective Practice and Organisation of Care (EPOC) criteria for risk of bias tool. Discrepancies will be resolved by consensus or by consulting a third author. Meta-analysis using a random effects model will be used to combine data. Where significant heterogeneity is present, data will be combined in a narrative synthesis. The findings will be reported according to the preferred reporting items for systematic reviews (PRISMA) statement.DiscussionInformation on the effects of early postnatal discharge from hospital will be important for policy makers and clinicians providing maternity care. This review will also identify any gaps in the current literature on this topic and provide direction for future research in this area of study.Systematic review registrationPROSPERO CRD42015020545Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0193-9) contains supplementary material, which is available to authorized users.

Newborn Length of Stay and Risk of Readmission

“…There is a lack of robust evidence for current postpartum practice on newborn LOS, particularly for safe discharge of babies born early term (37–38 weeks’ gestation) or late preterm (34–36 weeks’ gestation), who are at particularly high risk of early readmission for jaundice or feeding problems . We therefore explored four approaches for modelling the association between newborn LOS and risk of readmission, and assessed the impact of unmeasured confounding by clinical condition after birth.…”

“…2 Evidence on safe early discharge is conflicting. [3][4][5] Much of the evidence comes from the United States, where rates of neonatal readmissions declined following legislation in 1996 mandating insurance for a minimum 48-h hospital stay for normal deliveries. [6][7][8] However, several observational studies have demonstrated that decreasing the length of postpartum stay does not increase readmission rates, given adequate postnatal care outside of hospital.…”

The Support for New Mums Project: A protocol for a pilot randomized controlled trial designed to test a postnatal psychoeducation smartphone application

“…The length of postnatal hospital stay has been suggested as a possible factor contributing to dissatisfaction with postnatal care amongst childbearing women. Globally there has been a decreasing trend in the length of postnatal stay for women in western countries who choose to birth in hospital (Brown, Small, Argus, Davis, & Krastev, ; Jones, Taylor, MacArthur, Pritchett, & Cummins, ). This decreasing length of stay has led to early discharge policies that according to Jones et al.…”

“…A survey of mothers in the state of Victoria revealed that only 50% of women rated their postnatal care as 'very good' in comparison to antenatal (67% very good) and intrapartum care (72% very good) (McLachlan et al, 2009) The length of postnatal hospital stay has been suggested as a possible factor contributing to dissatisfaction with postnatal care amongst childbearing women. Globally there has been a decreasing trend in the length of postnatal stay for women in western countries who choose to birth in hospital (Brown, Small, Argus, Davis, & Krastev, 2009;Jones, Taylor, MacArthur, Pritchett, & Cummins, 2016).…”

“…This decreasing length of stay has led to early discharge policies that according to Jones et al (2016) were initiated to accommodate the global increase in birth rates (Jones et al, 2016).…”