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Scroggins JK, Bruce KE, Stuebe AM, Fahey JO, Tully KP. Identification of postpartum symptom informedness and preparedness typologies and their associations with psychological health: A latent class analysis. Midwifery 2024; 137:104115. [PMID: 39094534 DOI: 10.1016/j.midw.2024.104115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/10/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Birthing parents, defined as postpartum women and people with various gender identities who give birth, commonly experience challenging postpartum symptoms. However, many report feeling uninformed and unprepared to navigate their postpartum health. OBJECTIVE To identify typologies of postpartum symptom informedness and preparedness using latent class analysis (LCA) and to examine the associated patient and healthcare characteristics. METHODS We used survey data from a large, multi-method, longitudinal research project Postnatal Safety Learning Lab. Participants were recruited using convenience sampling and enrolled between November 2020 and June 2021. LCA was used to identify subgroups of birthing parents with different symptom informedness and preparedness using 10 binary variables (N = 148). Bivariate analysis was conducted to examine the association between characteristics and each typology. FINDINGS The 3-class models had better fit indices and interpretability for both informedness and preparedness typologies: High, High-moderate, and Moderate-low. The sample characteristics were different by typologies. In the modified discrimination in medical settings assessment, we found higher discrimination scores in the moderate-low informedness and preparedness typologies. The moderate-low preparedness typology had a higher percentage of birthing parents who did not have private insurance, underwent cesarean section, and planned for formula or mixed infant feeding. The median PHQ-4 scores at 4 weeks postpartum were lower among those in high informedness and preparedness typologies. CONCLUSION In our sample, 18 to 21 % of birthing parents were in the moderate-low informedness or preparedness typologies. Future research and practice should consider providing tailored information and anticipatory guidance as a part of more equitable and supportive care.
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Affiliation(s)
- Jihye Kim Scroggins
- School of Nursing, Columbia University, 560W 168th Street, New York, NY, USA.
| | - Katharine E Bruce
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, USA
| | - Alison M Stuebe
- Department of Obstetrics and Gynecology, Gillings School of Global Public Health, and Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, 3010 Old Clinic Building, Chapel Hill, NC, USA
| | - Jenifer O Fahey
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Maryland, 655W. Baltimore Street, Baltimore, MD, USA
| | - Kristin P Tully
- Department of Obstetrics and Gynecology and Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, 3009 Old Clinic Building, Chapel Hill, NC, USA
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Cao W, Li G, Guo Y, Liu X, Wang H, Gao H. Parental readiness for hospital discharge and the relationship with growth and development of infant in China. J Pediatr Nurs 2024; 75:e112-e118. [PMID: 38184478 DOI: 10.1016/j.pedn.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/01/2024] [Accepted: 01/01/2024] [Indexed: 01/08/2024]
Abstract
PURPOSE This study aimed to evaluate the associations between parental readiness for discharge and neonatal growth. DESIGN AND METHODS This cross-sectional study included 549 newborns whose parents filled out the Newborn-Parental Readiness for Discharge Scale (N-PRDS).Additionally, data on birth weight, length, and head circumference were collected.The total N-PRDS scores were divided into three levels in terms of readiness: low, intermediate, and high readiness. Parents and infants were followed up 42 days after the birth, and the weight, length, and head circumference of the newborns were measured at the hospital. RESULTS A total of 306 data were obtained. The generalized linear mixed model (GLMM) showed that time and parental readiness had an interaction effect on the weight, length and head circumference of infants. The difference in weight between infants under the high and low readiness conditions at 42 days increased by 0.357 kg compared to the difference at birth. The difference in length between high readiness infants and low readiness infants at 42 days increased by 2.155 cm compared to the difference at birth. The difference between the infants' head circumference under the high and low readiness conditions at 42 days was 0.873 cm higher than that at birth. CONCLUSIONS High readiness for discharge could promote an increase in infant weight, length,and head circumference at 42 days after birth. PRACTICE IMPLICATIONS Nurses should assess parental readiness prior to the discharge of newborns by using the N-PRDS and provide discharge guidance and education to newborns' parents based on the outcomes of this scale.
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Affiliation(s)
- Wenpei Cao
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Guirong Li
- Department of Neonatology, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Yu Guo
- Department of Neonatology, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Xiaoning Liu
- School of Public Health, Lanzhou University, Lanzhou, China.
| | - Hongyan Wang
- Department of Neonatology, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Hongxia Gao
- Department of Neonatology, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
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Hall M, Afzal A, White DE. Single Room Maternity Care Versus Traditional Maternity Care: A Cross-Sectional Study Examining Differences in Mothers' Perceptions of Readiness for Discharge and Satisfaction and Health Outcomes. Can J Nurs Res 2023; 55:345-353. [PMID: 36945743 PMCID: PMC10416552 DOI: 10.1177/08445621231165233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Single room maternity care (SRMC) includes all aspects of the birth process (labour, delivery, postpartum) in a single room with a consistent team of healthcare providers. Traditional maternity care (TMC) involves having mothers labouring and delivering their baby in one room and then transferring to a room on another unit, which also means a transition in providers. Although many hospitals have transitioned to SRMC, there has been limited evidence to support their development. METHODS This study was conducted in two large hospitals (one offering SRMC, the other TMC) in Western Canada. A cross-sectional between-subjects design was used to compare differences between SRMC and TMC. New mothers were asked to complete validated questionnaires. Health information was collected from administrative and health databases. The main outcomes included readiness for hospital discharge, mothers' satisfaction, newborn length of stay, and mother length of stay. Several covariates were examined. RESULTS In total, 506 (292 SRMC; 214 TMC) mothers participated. Readiness for discharge and maternal satisfaction were significantly higher in SRMC. Although newborn and mother length of stay were significantly reduced in SRMC compared to TMC for univariate tests, mother length of stay was not significantly different when adjusting for other variables. CONCLUSIONS There are positive health and psychosocial outcomes for mothers and newborns in the SRMC model of care compared to TMC. Since readiness for discharge and satisfaction are associated with positive maternal-infant interactions and transitions to community, SRMC could be the better approach. Further research should examine healthcare provider outcomes and implementation costs.
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Affiliation(s)
- Marc Hall
- Faculty of Nursing, University of Calgary, Calgary, Canada
| | - Arfan Afzal
- Faculty of Nursing, University of Calgary, Calgary, Canada
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Bernstein HH, Slora EJ, Mathias-Prabhu T, Park HS, Spino C. Association of Severe Acute Respiratory Syndrome Coronavirus 2 Infection With Early Breastfeeding. Acad Pediatr 2023; 23:343-350. [PMID: 36240984 PMCID: PMC9554206 DOI: 10.1016/j.acap.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/07/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The association of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) status before delivery with breastfeeding is unknown. This study compares breastfeeding initiation, exclusivity, and duration between SARS-CoV-2-positive (+) and SARS-CoV-2-negative (-) mothers during the first 2 months of their newborns' lives. METHODS A single center, retrospective cohort study of pediatric contacts during the first 2 months in a diverse mother-infant population (n = 285) compared breastfeeding outcomes by maternal SARS-CoV-2 status during a pandemic surge. Infants of SARS-CoV-2 positive mothers were also tested before discharge. Comparison of maternal demographics (age, race, ethnicity), maternal/infant characteristics (parity, insurance, delivery mode, infant sex, hospital length of stay), and pediatric contacts by maternal SARS-CoV-2 status included Fisher's exact and Wilcoxon tests and Poisson regression for count outcomes. Logistic regression compared breastfeeding outcomes between the 2 groups, adjusting for potential confounders and effect modifiers. RESULTS Maternal demographics and maternal/infant characteristics were similar. While 19% of mothers tested positive for SARS-CoV-2 (n = 54), their infants were all negative. SARS-CoV-2 positive mothers had fewer in-person, but more virtual pediatric contacts. After controlling for the above variables, SARS-CoV-2 positive mothers had lower odds of breastfeeding initiation within 1 to 7 days of life (78% vs 88%; adjusted odds ratio [aOR] = 0.40, 95% confidence interval [CI]: 0.17, 0.96) and of any breastfeeding during month 2 (54% vs 76%; aOR = 0.37, 95% CI: 0.16, 0.86) compared with SARS-CoV-2 negative mothers. CONCLUSIONS Maternal SARS-CoV-2 positivity at delivery was independently associated with less initiation and shorter duration of any breastfeeding during month 2. SARS-CoV-2 positive women would likely benefit from additional breastfeeding support during pandemic surges.
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Affiliation(s)
- Henry H Bernstein
- Cohen Children's Medical Center (HH Bernstein, EJ Slora, T Mathias-Prabhu, and HS Park), New Hyde Park, NY; Zucker School of Medicine at Hofstra/Northwell (HH Bernstein), Hempstead, NY.
| | - Eric J Slora
- Cohen Children's Medical Center (HH Bernstein, EJ Slora, T Mathias-Prabhu, and HS Park), New Hyde Park, NY
| | - Tara Mathias-Prabhu
- Cohen Children's Medical Center (HH Bernstein, EJ Slora, T Mathias-Prabhu, and HS Park), New Hyde Park, NY
| | - Hee Su Park
- Cohen Children's Medical Center (HH Bernstein, EJ Slora, T Mathias-Prabhu, and HS Park), New Hyde Park, NY
| | - Cathie Spino
- University of Michigan (C Spino), Ann Arbor, Mich
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Lau E, Adams YJ, Ghiaseddin R, Sobiech K, Ehla EE. Discharge Readiness and Associated Factors Among Postpartum Women in Tamale, Ghana. West J Nurs Res 2023; 45:539-546. [PMID: 36782383 DOI: 10.1177/01939459231152122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Ghana experiences a relatively high maternal mortality ratio, with the majority of maternal deaths occurring in the postpartum period. Discharge readiness is a reliable indicator of maternal health outcomes and involves a postpartum woman's perception of preparedness to leave the hospital following delivery. We measured the discharge readiness of postpartum women in Ghana through an institutional-based cross-sectional study involving 151 participants. Participants completed an interviewer-administered survey, and data analyses included linear regression models. The study sample demonstrated relatively high discharge readiness, with a mean score of 177.57 on a scale from 0.00 to 220.00. Higher gravidity was positively associated with discharge readiness score, while longer length of hospital stay and receiving educational handouts were negatively associated with discharge readiness score. Clinical interventions addressing the factors found to be associated with discharge readiness have significant potential to improve postpartum care and maternal outcomes in Ghana.
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Affiliation(s)
- Elizabeth Lau
- College of Science, University of Notre Dame, Notre Dame, IN, USA
| | | | - Roya Ghiaseddin
- Department of Applied and Computational Mathematics & Statistics, University of Notre Dame, Notre Dame, IN, USA
| | - Kathleen Sobiech
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
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Ran M, Songwathana P, Damkliang J. Discharge readiness and its associated factors among first-time mothers undergoing cesarean section in China. BELITUNG NURSING JOURNAL 2022; 8:497-504. [PMID: 37554237 PMCID: PMC10405666 DOI: 10.33546/bnj.2341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/02/2022] [Accepted: 11/28/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Helping first-time mothers who have just undergone cesarean section and transitioning from hospital to home with their infant is a complex process. Therefore, understanding what contributes to discharge readiness is necessary. OBJECTIVE This study aimed to determine discharge readiness level and its associated factors among first-time mothers who have undergone cesarean section. METHODS A descriptive cross-sectional study was conducted among 233 first-time mothers who had undergone cesarean sections selected using quota sampling from the two largest referral centers in China. Data were collected from March to June 2021 using a demographic characteristics form, Readiness for Hospital Discharge Scale-New Mother Form (RHDS-NMF), and Quality Discharge Teaching Scale-New Mother Form (QDTS-NMF). Descriptive and inferential statistics were used for data analysis. RESULTS The discharge readiness of the respondents was at a moderate level. Age (r = -0.129, p = 0.049) and complications after cesarean section (r = -0.136, p = 0.038) had a negative correlation with discharge readiness. In contrast, the subscales of QDTS-NMF, particularly the content (r = 0.519, p = 0.000) and delivery (r = 0.643, p = 0.000), had a positive correlation with discharge readiness. CONCLUSION The findings enable nurses, midwives, and other healthcare professionals to understand discharge readiness and its related factors among first-time mothers undergoing cesarean section. It is also suggested that the quality of discharge teaching with a comprehensive assessment of first-time mothers preparing for discharge from the hospital and following the guideline to prevent post-cesarean section complications should be reinforced.
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Affiliation(s)
- Mingfei Ran
- Faculty of Nursing, Prince of Songkla University, Thailand
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曹 文, 李 桂, 郭 宇, 王 建, 郑 鑫, 刘 小. [Association between neonatal discharge preparedness and adverse health events]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1001-1007. [PMID: 36111718 PMCID: PMC9495242 DOI: 10.7499/j.issn.1008-8830.2203185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/11/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To study the association between neonatal discharge preparedness and adverse health events. METHODS The neonates who were born in hospitals from different regions of Gansu Province in China and their parents were enrolled as subjects, and an investigation was performed for the discharge preparedness. According to the level of discharge preparedness, the subjects were divided into low-, middle-, and high-level groups. The neonates were followed up to observe the incidence rate of adverse health events within one month after discharge. The association between neonatal discharge preparedness and adverse health events was analyzed. RESULTS The neonates with adverse health events had a significantly lower level of discharge preparedness than those without adverse events (P<0.05). The multivariate logistic regression analysis showed that the incidence rate of adverse health events was reduced by 34.8% in the middle-level group and 78.7% in the high-level group compared with the low-level group (P<0.05). The readmission rate of neonates was 8.1% (35/430), and the neonates readmitted had a significantly lower level of discharge preparedness than those not readmitted (P<0.05). The multivariate logistic regression analysis showed that the readmission rate of neonates was reduced by 67.4% in the middle-level group and 84.2% in the high-level group compared with the low-level group (P<0.05). CONCLUSIONS Discharge preparedness may affect the incidence of adverse health events and the rate of readmission within one month after discharge. Medical staff should adopt effective intervention measures to improve discharge preparedness, so as to reduce the incidence of adverse health events and the rate of readmission.
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Adams YJ, Lau E, Young J, Ehla EE. Cross-Cultural Adaptation and Validation of the Dagbani Readiness for Hospital Discharge Scale-New Mother. J Obstet Gynecol Neonatal Nurs 2022; 51:620-630. [PMID: 35988695 DOI: 10.1016/j.jogn.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022] Open
Abstract
The Readiness for Hospital Discharge Scale-New Mother (RHDS-NM), originally developed for use in English-speaking populations, is an instrument designed to measure women's perceptions of readiness for hospital discharge after birth. We translated and cross-culturally adapted the RHDS-NM into Dagbani and conducted reliability and validity assessments of the new Dagbani RHDS-NM in the Tamale Metropolitan Area, Ghana. The average scale-level content validity index was excellent at 1.00. The Dagbani RHDS-NM had a Cronbach's α reliability coefficient of .94. Exploratory factor analysis indicated four factors with Cronbach's α reliability coefficients of .958, .915, .899, and .667 that represented the Personal Status, Knowledge, Expected Support, and Coping Ability subscales, respectively. Our findings provide initial evidence to support the reliability and validity of the Dagbani RHDS-NM.
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McCarter D, Law AA, Cabullo H, Pinto K. Scoping Review of Postpartum Discharge Education Provided by Nurses. J Obstet Gynecol Neonatal Nurs 2022; 51:377-387. [PMID: 35483423 PMCID: PMC9257451 DOI: 10.1016/j.jogn.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine what is known about postpartum education provided by nurses to women before discharge from the hospital after birth and whether current nursing practices are effective to prepare women to identify warning signs of complications, perform self-care (physical and emotional), prepare for parenting a newborn, and establish infant feeding. DATA SOURCES We conducted a systematic search of CINAHL Plus and MEDLINE for relevant sources, including peer-reviewed articles, conference presentations, and guidelines from professional organizations, that were published in English from January 2010 through November 30, 2020. STUDY SELECTION We included sources if participants were women who had given birth to a healthy, liveborn, term infant and were receiving education in whole or in part by a nurse during the maternity hospitalization. We excluded sources with samples of high-risk women or those who gave birth to high-risk infants (preterm, congenital anomalies, neonatal abstinence syndrome). Forty-six of the sources met the inclusion criteria. DATA EXTRACTION We extracted citation, type of document, country of origin, context (prenatal/postpartum or both and inpatient/outpatient or both), aim, participants (mother/father or both, sample characteristics), content of education and who provided it, outcomes or key themes, and main results. DATA SYNTHESIS Infant topics included breastfeeding and safe sleep, and maternal topics included breastfeeding, postpartum mood, and self-care after birth. Nurses prioritized safety, including safe sleep; preventing infant falls; decreasing infection; screening for postpartum depression; and avoiding adverse outcomes after discharge. Women focused on self-care, pain management, infant care, and parenting. Women and nurses prioritized breastfeeding. Authors of the included sources measured effectiveness by patient satisfaction, chart audit, pre- and posttests of nurses' knowledge, and breastfeeding duration. Women reported barriers to postpartum education such as limited nursing time or conflicting information. CONCLUSION Postpartum education is a priority, but its effectiveness is not well studied. Few maternal or infant health-centered outcomes have been measured beyond breastfeeding duration. Nursing care and nurse expertise are not easily quantified or measured. Research is needed to inform best practices for postpartum education.
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Smith H, Harvey C, Portela A. Discharge preparation and readiness after birth: a scoping review of global policies, guidelines and literature. BMC Pregnancy Childbirth 2022; 22:281. [PMID: 35382773 PMCID: PMC8985304 DOI: 10.1186/s12884-022-04577-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
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: https://doi.org/10.17504/protocols.io.bpzymp7w.
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Affiliation(s)
- Helen Smith
- International Health Consulting Services Ltd, Merseyside, UK.
| | | | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Hochreiter D, Kuruvilla D, Grossman M, Silberg J, Rodriguez A, Lary L, Panosky K, Loyal J. Improving Guidance and Maternal Knowledge Retention After Well-Newborn Unit Discharge. Hosp Pediatr 2022; 12:148-156. [PMID: 35075487 DOI: 10.1542/hpeds.2021-006307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES In 2015, the American Academy of Pediatrics published a policy statement to provide best practices on mother-infant discharge criteria, including the delivery of anticipatory guidance to mothers of healthy newborns. In our large health system with a mix of hospital types, no standard approach to or measurement of the effectiveness of newborn discharge guidance exists. At one community well-newborn unit, we aimed to increase maternal knowledge retention of newborn guidance from 69% to 90%. METHODS Data about newborn guidance effectiveness were collected by assessing maternal knowledge retention through phone follow-up quizzes. By using quality improvement methodology and informed by American Academy of Pediatrics guidelines and curricular and adult learning theory, we standardized a multidisciplinary approach to this education. Interventions included checklist, scripts, temperature-taking demonstration, gift thermometer, staff education, car seat infant mannequin, and car seat training video for staff. RESULTS Over a 1-year period, 333 mothers were interviewed after discharge from the well-newborn unit. Baseline data over the first 3 months (n = 93) showed poor maternal knowledge retention (69% correct answers). Common incorrect answers were on newborn urination habits, car seat harness clip positioning, and fever recognition. After restructuring the educational process, special cause was achieved after 3 months, with a shift of the average of correct answers to 83% followed by a second shift to 86%. CONCLUSIONS The implementation of interventions to standardize newborn discharge guidance resulted in marked and sustained improvement in maternal knowledge after well-newborn unit discharge. Our next step is to enhance the process by using videos with systemwide implementation.
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Affiliation(s)
- Daniela Hochreiter
- Division of Hospitalist Medicine, Department of Pediatrics, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Danice Kuruvilla
- Division of Hospitalist Medicine, Department of Pediatrics, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Matthew Grossman
- Division of Hospitalist Medicine, Department of Pediatrics, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Jordan Silberg
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Alexis Rodriguez
- Division of Hospitalist Medicine, Department of Pediatrics, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Lauren Lary
- Lawrence and Memorial Hospital, Yale New Haven Health, New London, Connecticut
| | - Kelsey Panosky
- Lawrence and Memorial Hospital, Yale New Haven Health, New London, Connecticut
| | - Jaspreet Loyal
- Division of Hospitalist Medicine, Department of Pediatrics, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
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Handley SC, Gallagher K, Breden A, Lindgren E, Lo JY, Son M, Murosko D, Dysart K, Lorch SA, Greenspan J, Culhane JF, Burris HH. Birth Hospital Length of Stay and Rehospitalization During COVID-19. Pediatrics 2022; 149:e2021053498. [PMID: 34889449 PMCID: PMC9645693 DOI: 10.1542/peds.2021-053498] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To determine if birth hospitalization length of stay (LOS) and infant rehospitalization changed during the coronavirus disease 2019 (COVID-19) era among healthy, term infants. METHODS Retrospective cohort study using Epic's Cosmos data from 35 health systems of term infants discharged ≤5 days of birth. Short birth hospitalization LOS (vaginal birth <2 midnights; cesarean birth <3 midnights) and, secondarily, infant rehospitalization ≤7 days after birth hospitalization discharge were compared between the COVID-19 (March 1 to August 31, 2020) and prepandemic eras (March 1 to August 31, 2017, 2018, 2019). Mixed-effects models were used to estimate adjusted odds ratios (aORs) comparing the eras. RESULTS Among 202 385 infants (57 110 from the COVID-19 era), short birth hospitalization LOS increased from 28.5% to 43.0% for all births (vaginal: 25.6% to 39.3%, cesarean: 40.1% to 61.0%) during the pandemic and persisted after multivariable adjustment (all: aOR 2.30, 95% confidence interval [CI] 2.25-2.36; vaginal: aOR 2.12, 95% CI 2.06-2.18; cesarean: aOR 3.01, 95% CI 2.87-3.15). Despite shorter LOS, infant rehospitalizations decreased slightly during the pandemic (1.2% to 1.1%); results were similar in adjusted analysis (all: aOR 0.83, 95% CI 0.76-0.92; vaginal: aOR 0.82, 95% CI 0.74-0.91; cesarean: aOR 0.87, 95% CI 0.69-1.10). There was no change in the proportion of rehospitalization diagnoses between eras. CONCLUSIONS Short infant LOS was 51% more common in the COVID-19 era, yet infant rehospitalization within a week did not increase. This natural experiment suggests shorter birth hospitalization LOS among family- and clinician-selected, healthy term infants may be safe with respect to infant rehospitalization, although examination of additional outcomes is needed.
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Affiliation(s)
- Sara C. Handley
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | | | | | | | | | - Moeun Son
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Daria Murosko
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kevin Dysart
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott A. Lorch
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Jay Greenspan
- Division of Neonatology, Nemours duPont Pediatrics, Philadelphia, Pennsylvania
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Heather H. Burris
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
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Abstract
In this section, we present Interdisciplinary Guidelines and Recommendations for Neonatal Intensive Care Unit (NICU) Discharge Preparation and Transition Planning. The foundation for these guidelines and recommendations is based on existing literature, practice, available policy statements, and expert opinions. These guidelines and recommendations are divided into the following sections: Basic Information, Anticipatory Guidance, Family and Home Needs Assessment, Transfer and Coordination of Care, and Other Important Considerations. Each section includes brief introductory comments, followed by the text of the guidelines and recommendations in table format. After each table, there may be further details or descriptions that support a guideline or recommendation. Our goal was to create recommendations that are both general and adaptable while also being specific and actionable. Each NICU's implementation of this guidance will be dependent on the unique makeup and skills of their team, as well as the availability of local programs and resources. The recommendations based only on expert opinion could be topics for future research.
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Gooding C, Lavin T, van Rooyen E, Bergh AM, Preen DB. Evaluating Maternal Discharge Readiness in Kangaroo Mother Care. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2324-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gao H, Wu C, Huang D, Zha D, Zhou C. Health Information Integration Based on Network Platform in Postpartum Maternal and Infant Health Care. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: The self-care ability of puerpera is poor, and their health knowledge of maternal and infant and care skills is relatively poor. The aim of our study was to investigate the effect of health information integration based on network platform in the postpartum maternal
and infant health care. Methods: A total of 80 maternal women admitted to our hospital from September 2018 to March 2019 were randomly divided into a control group and a study group, with 40 patients in each group. The puerpera in control group received regular telephone visits after
discharge. The puerpera in study group received health information integration based on network platform. The uterus recovery of puerpera in two groups at 42 days postpartum, as well as the lochia, bloating, nipple splitting and breastfeeding behaviors were compared. The time of jaundice regression
and umbilical cord detachment of neonates in t two groups, as well as the incidence of facial eczema and umbilical inflammation were compared. Results: The uterus recovery rate and exclusive breastfeeding rate of puerpera in study group were higher than those in the control group at
42 days postpartum, and the incidences of abnormal lochia, swollen breasts, and nipple splitting were lower than those in the control group. The difference between the two groups was statistically significant (P < 0.05). The neonates in study group were lower than the observation
group in terms of the days of jaundice regression, facial eczema, and umbilical inflammation. The difference between the two groups was statistically significant (P < 0.05). However, there was no significant difference in the days of umbilical cord shedding (P > 0.05). Conclusions:
The health information integration based on network platform in postpartum maternal and infant health care can effectively improve maternal breastfeeding compliance and reduce the adverse symptoms of maternal and neonatal discharge.
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Affiliation(s)
- Hong Gao
- The Third People's Hospital of HeFei, Heifei 230022, Anhui Province, China
| | - Cuiyun Wu
- The Third People's Hospital of HeFei, Heifei 230022, Anhui Province, China
| | - Dunnian Huang
- The Third People's Hospital of HeFei, Heifei 230022, Anhui Province, China
| | - Dahui Zha
- The Third People's Hospital of HeFei, Heifei 230022, Anhui Province, China
| | - Cuiping Zhou
- The Third People's Hospital of HeFei, Heifei 230022, Anhui Province, China
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Consensus Bundle on Postpartum Care Basics: From Birth to the Comprehensive Postpartum Visit. Obstet Gynecol 2021; 137:33-40. [PMID: 33278281 DOI: 10.1097/aog.0000000000004206] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/09/2020] [Indexed: 01/31/2023]
Abstract
In the weeks after childbirth, a woman navigates multiple challenges. She must recover from birth, learn to care for herself and her newborn, and cope with fatigue and postpartum mood changes as well as chronic health conditions. Alongside these common morbidities, the number of maternal deaths in the United States continues to increase, and unacceptable racial inequities persist. One third of pregnancy-related deaths occur between 1 week and 1 year after delivery, with a growing proportion of these deaths due to cardiovascular disease; one fifth occur between 7 and 42 days postpartum. In addition, pregnancy-associated deaths due to self-harm or substance misuse are increasing at an alarming rate. Rising maternal mortality and morbidity rates, coupled with significant disparities in outcomes, highlight the need for tailored interventions to improve safety and well-being of families during the fourth trimester of pregnancy, which includes the period from birth to the comprehensive postpartum visit. Targeted support for growing families during this transition can improve health and well-being across generations.
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Soghier LM, Kritikos KI, Carty CL, Glass P, Tuchman LK, Streisand R, Fratantoni KR. Parental Depression Symptoms at Neonatal Intensive Care Unit Discharge and Associated Risk Factors. J Pediatr 2020; 227:163-169.e1. [PMID: 32681990 DOI: 10.1016/j.jpeds.2020.07.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To investigate the prevalence and risk factors associated with parental depressive symptoms at neonatal intensive care unit (NICU) discharge and determine the relationships among depressive symptoms, stress, and social support. STUDY DESIGN Parents participating in the Giving Parents Support trial (n = 300) were surveyed before NICU discharge. Depressive symptoms, stress, and social support were assessed using the Center for Epidemiological Studies Depression Scale (CESD-10), Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU), Perceived Stress Scale (PSS-10), and Multidimensional Scale of Perceived Social Support (MSPSS). Regression analyses examined relationships among depressive symptoms, stress, social support, and parent/infant factors. RESULTS At NICU discharge, 45% of parents reported depressive symptoms and 43% reported elevated perceived stress. Increased odds of elevated depressive symptoms were associated with older gestational age (P = .02), female infant (P = .02), and longer length of stay (P = .045). Odds of depression were 7.87 (95% CI, 2.15-28.75) for parents of infants with gestational age ≥37 weeks compared with gestational age <28 weeks. Parental NICU stress was higher in younger parents (P < .01). Depressive symptoms were positively associated with parental stress. Each 1-point increase in PSS:NICU score was associated with a 2.1-point (95% CI, 1.6-2.9; P < .001) increase in CESD-10 score. Social support was inversely associated with depressive symptoms. CONCLUSION The prevalence of depressive symptoms in parents at NICU discharge was high, even among parents of term infants. Older gestational age, greater parental stress, and lower levels of social support were strong correlates of depressive symptoms. Strategies to support parents, including depression screening, stress reduction strategies, and mental health referrals, are needed.
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Affiliation(s)
- Lamia M Soghier
- Department of Neonatology, Children's National Hospital, Washington, DC; Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC.
| | - Katherine I Kritikos
- Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC
| | - Cara L Carty
- Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC
| | - Penny Glass
- Department of Neonatology, Children's National Hospital, Washington, DC; Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC; Department of Psychology and Behavioral Health, Children's National Hospital, Washington, DC
| | - Lisa K Tuchman
- Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC; Department of Adolescent and Young Adult Medicine, Children's National Hospital, Washington, DC
| | - Randi Streisand
- Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC; Department of Psychology and Behavioral Health, Children's National Hospital, Washington, DC
| | - Karen R Fratantoni
- Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC; Division of General and Community Pediatrics, Children's National Hospital, Washington, DC
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Management of neonates after postpartum discharge and all children in the ambulatory setting during the coronavirus disease 2019 (COVID-19) pandemic. Curr Opin Pediatr 2020; 32:610-618. [PMID: 32618790 PMCID: PMC7363367 DOI: 10.1097/mop.0000000000000931] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The present coronavirus disease 2019 (COVID-19) pandemic has created additional challenges with an increased number of presumed healthy, full-term newborns being discharged at 24 h after delivery. Short lengths of stay raise the possibility of mother-infant dyads being less ready for discharge, defined as at least one of the three informants (i.e., mother, pediatrician, and obstetrician) believing that either the mother and/or infant should stay longer than the proposed time of discharge. This public health crisis has reduced the number of in-person well child visits, negatively impacting vaccine receipt, and anticipatory guidance. RECENT FINDINGS Extra precautions should be taken during the transition period between postpartum discharge and follow-up in the ambulatory setting to ensure the safety of all patients and practice team members. This should include restructuring office flow by visit type and location, limiting in-person visits during well infant exams, instituting proper procedures for personal protective equipment and for cleaning of the office, expanding telehealth capabilities for care and education, and prioritizing universal vaccinations and routine well child screenings. SUMMARY Based on current limited evidence, this report provides guidance for the postdischarge management of newborns born to mothers with confirmed or suspected disease in the ambulatory setting as well as prioritizing universal immunizations and routine well child screenings during the COVID-19 pandemic.
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Cegolon L, Maso G, Heymann WC, Bortolotto M, Cegolon A, Mastrangelo G. Determinants of Length of Stay After Vaginal Deliveries in the Friuli Venezia Giulia Region (North-Eastern Italy), 2005-2015. Sci Rep 2020; 10:5912. [PMID: 32249795 PMCID: PMC7136236 DOI: 10.1038/s41598-020-62774-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 03/19/2020] [Indexed: 11/28/2022] Open
Abstract
Although length of stay (LoS) after childbirth has been diminishing in several high-income countries in recent decades, the evidence on the impact of early discharge (ED) on healthy mothers and term newborns after vaginal deliveries (VD) is still inconclusive and little is known on the characteristics of those discharged early. We conducted a population-based study in Friuli Venezia Giulia (FVG) during 2005-2015, to investigate the mean LoS and the percentage of LoS longer than our proposed ED benchmarks following VD: 2 days after spontaneous vaginal deliveries (SVD) and 3 days post instrumental vaginal deliveries (IVD). We employed a multivariable logistic as well as a linear regression model, adjusting for a considerable number of factors pertaining to health-care setting and timeframe, maternal health factors, newborn clinical factors, obstetric history factors, socio-demographic background and present obstetric conditions. Results were expressed as odds ratios (OR) and regression coefficients (RC) with 95% confidence interval (95%CI). The adjusted mean LoS was calculated by level of pregnancy risk (high vs. low). Due to a very high number of multiple tests performed we employed the procedure proposed by Benjamini-Hochberg (BH) as a further selection criterion to calculate the BH p-value for the respective estimates. During 2005-2015, the average LoS in FVG was 2.9 and 3.3 days after SVD and IVD respectively, and the pooled regional proportion of LoS > ED was 64.4% for SVD and 32.0% for IVD. The variation of LoS across calendar years was marginal for both vaginal delivery modes (VDM). The adjusted mean LoS was higher in IVD than SVD, and although a decline of LoS > ED and mean LoS over time was observed for both VDM, there was little variation of the adjusted mean LoS by nationality of the woman and by level of pregnancy risk (high vs. low). By contrast, the adjusted figures for hospitals with shortest (centres A and G) and longest (centre B) mean LoS were 2.3 and 3.4 days respectively, among "low risk" pregnancies. The corresponding figures for "high risk" pregnancies were 2.5 days for centre A/G and 3.6 days for centre B. Therefore, the shift from "low" to "high" risk pregnancies in all three latter centres (A, B and G) increased the mean adjusted LoS just by 0.2 days. By contrast, the discrepancy between maternity centres with highest and lowest adjusted mean LoS post SVD (hospital B vs. A/G) was 1.1 days both among "low risk" (1.1 = 3.4-2.3 days) and "high risk" (1.1 = 3.6-2.5) pregnanices. Similar patterns were obseved also for IVD. Our adjusted regression models confirmed that maternity centres were the main explanatory factor for LoS after childbirth in both VDM. Therefore, health and clinical factors were less influential than practice patterns in determining LoS after VD. Hospitalization and discharge policies following childbirth in FVG should follow standardized guidelines, to be enforced at hospital level. Any prolonged LoS post VD (LoS > ED) should be reviewed and audited if need be. Primary care services within the catchment areas of the maternity centres of FVG should be improved to implement the follow up of puerperae undergoing ED after VD.
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Affiliation(s)
- L Cegolon
- Local Health Unit N.2 "Marca Trevigiana", Public Health Department, Veneto Region, Treviso, Italy.
- Institute for Maternal & Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
| | - G Maso
- Local Health Unit N.2 "Marca Trevigiana", Public Health Department, Veneto Region, Treviso, Italy
| | - W C Heymann
- Florida State University, Department of Clinical Sciences, College of Medicine, Sarasota, Florida, USA
- Florida Department of Health, Sarasota County Health Department, Sarasota, Florida, USA
| | - M Bortolotto
- Padua University, FISPPA Department, Padua, Italy
| | - A Cegolon
- University of Macerata, Department of Political, Social & International Relationships, Macerata, Italy
| | - G Mastrangelo
- Padua University, Department of Cardio-Thoracic & Vascular Sciences, Padua, Italy
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McCarter D, MacLeod CE. What Do Women Want? Looking Beyond Patient Satisfaction. Nurs Womens Health 2019; 23:478-484. [PMID: 31672402 DOI: 10.1016/j.nwh.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/23/2019] [Accepted: 09/01/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To hear the voices of women, their partners, and nurses about expectations and priorities during the postpartum hospitalization. DESIGN Focus groups using semistructured interview questions. SETTING A 12-bed labor-delivery-recovery-postpartum unit at a small urban hospital in the U.S. Northeast. PARTICIPANTS Women who planned to or had given birth, their partners, and the maternity nurses who cared for them. MEASUREMENTS Qualitative thematic analysis of focus group transcripts. RESULTS Thematic analysis produced the following themes for women's priorities: Need for individualized attention to maternal physical and emotional care; Fear of providing inadequate care for the newborn, including establishing infant feeding; and Transitioning to parenting as a new mother versus as an experienced mother. Themes for nurses' priorities included Safety issues around sleep and breastfeeding, Transitioning to parenting with an emphasis on maternal self-care, and Addressing barriers to effective discharge education. Response comparisons between the women/partners and nurses suggest that there is a disconnection between women's and nurses' priorities and expectations for care during the postpartum period. CONCLUSION Women and nurses identified unmet needs in the postpartum period, consistent with the current literature. Providing standardized education during the transitional period around discharge from the hospital to home may not be optimal and may even detract from meeting the needs for rest and connection with family and the health care team. Nursing care that extends beyond the maternity hospitalization may be needed to individualize care and meet previously unmet needs.
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21
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Bornstein LM, Landers SE, Rosenthal SL, McCann TA. Physicians' Perceptions of Stakeholder Influence on Discharge Timing in a Children's Hospital. Glob Pediatr Health 2019; 6:2333794X19878596. [PMID: 31579686 PMCID: PMC6757495 DOI: 10.1177/2333794x19878596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 11/15/2022] Open
Abstract
Attending physicians (N = 53) at a nonprofit, university-affiliated academic children's hospital completed a survey about how key stakeholders affect timing of patient discharge beyond attending assessment of medical stability. Physicians perceived families and hospital administration as more often having an impact on discharge timing than they should and perceived members of the care team and peer physicians/consultants as less frequently having an impact than they should. All but one physician reported discharging a patient either earlier or later than they felt was appropriate due to pressure from at least one stakeholder group; almost all physicians had done so in response to pressure from families. When physicians changed discharge timing based on stakeholder pressure, they tended to extend hospital stay except in the case of administrative pressure. These findings highlight the need for improvements in communication regarding discharge goals and for future research on how navigating competing interests affect physician stress.
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Affiliation(s)
| | | | | | - Teresa A. McCann
- Columbia University Medical Center, New York, NY, USA
- Teresa A. McCann, Columbia University Medical Center, Vanderbilt Clinic Floor 4, Room 417, 622 West 168th Street, New York, NY 10032-3784, USA.
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22
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Gupta M, Pursley DM, Smith VC. Preparing for Discharge From the Neonatal Intensive Care Unit. Pediatrics 2019; 143:peds.2018-2915. [PMID: 31053622 DOI: 10.1542/peds.2018-2915] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Discharge readiness is a key determinant of outcomes for families in the NICU. Since 2003, using a broad set of outcome and process measures, we have conducted an ongoing quality improvement initiative to improve the discharge preparation process in our NICU and readiness of families being discharged from the NICU. METHODS Iterative improvements to the discharge preparation process were made by a multidisciplinary committee. Discharge readiness was measured by using a parental and nurse survey for all families discharged from our NICU. Primary outcome measures included parental self-assessment of discharge readiness and nurse assessment of the family's emotional and technical discharge readiness. Secondary outcome measures included assessment of specific technical skills and emotional factors. Process measures included nursing familiarity with family at discharge. Improvement over time was analyzed by using statistical process control charts. RESULTS Significant improvement was seen in all primary outcome measures. Family self-assessment of discharge readiness increased from 85.1% to 89.1%; nurse assessment of the family's emotional discharge readiness increased from 81.2% to 90.5%, and technical discharge readiness increased from 81.4% to 87.7%. Several secondary outcome measures revealed significant improvement, whereas most remained stable. Nurse familiarity with the family at discharge increased over time. CONCLUSIONS Quality improvement methodology can be used to measure and improve discharge readiness of families with an infant in the NICU. This model can provide the necessary framework for a structured approach to systematically evaluating and improving the discharge preparation process in a NICU.
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Affiliation(s)
- Munish Gupta
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - DeWayne M Pursley
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Vincent C Smith
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
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Lemyre B, Jefferies AL, O'Flaherty P. Facilitating discharge from hospital of the healthy term infant. Paediatr Child Health 2018; 23:515-531. [PMID: 30894791 DOI: 10.1093/pch/pxy127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This statement provides guidance for health care providers to ensure the safe discharge of healthy term infants who are born in hospital and who are ≥37 weeks' gestational age. Hospital care for mothers and infants should be family-centred, with healthy mothers and infants remaining together and going home at the same time. The specific length of stay for newborn infants depends on the health of their mother, infant health and stability, the mother's ability to care for her infant, support at home, and access to follow-up care. Many mother-infant dyads are ready to go home 24 h after birth. Parent or guardian education and assessment of discharge readiness are important components of discharge planning. Each infant must have an appropriate discharge plan, including identification of the infant's primary health care provider and assessment by a health care provider 24 h to 72 h after discharge.
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Affiliation(s)
- Brigitte Lemyre
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| | - Ann L Jefferies
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| | - Pat O'Flaherty
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
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Lemyre B, Jefferies AL, O’Flaherty P. Faciliter le congé du nouveau-né à terme et en santé. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brigitte Lemyre
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
| | - Ann L Jefferies
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
| | - Pat O’Flaherty
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
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Arora NS, Danicek AM, Osborn RR, Fried SQ, Negris OR, Lychuk K, Mychaliska KP, Skoczylas MS, Monroe KK. Adherence to AAP Healthy Newborn Discharge Criteria in a Tertiary Care Children's Hospital. Hosp Pediatr 2018; 8:665-671. [PMID: 30279199 DOI: 10.1542/hpeds.2018-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In 2015, the American Academy of Pediatrics (AAP) published an updated consensus statement containing 17 discharge recommendations for healthy term newborn infants. In this study, we identify whether the AAP criteria were met before discharge at a tertiary care academic children's hospital. METHODS A stratified random sample of charts from newborns who were discharged between June 1, 2015, and May 31, 2016, was reviewed. Of the 531 charts reviewed, 433 were included in the study. A review of each chart was performed, and data were collected. RESULTS Descriptive statistics for our study population (N = 433) revealed that all 17 criteria were followed <5% of the time. The following criteria were met 100% of the time: clinical course and physical examination, postcircumcision bleeding, availability of family members or health care providers to address follow-up concerns, anticipatory guidance, first appointment with the physician scheduled or parents knowing how to do so, pulse oximetry screening, and hearing screening. These criteria were met at least 95% to 99% of the time: appropriate vital signs, regular void and stool frequency, appropriate jaundice and sepsis management, and metabolic screening. The following criteria were met 50% to 95% of the time: maternal serologies, hepatitis B vaccination, and social risk factor assessment. Four of the criteria were met <50% of the time: feeding assessment, maternal vaccination, follow-up timing for newborns discharged at <48 hours of life, and car safety-seat assessment. CONCLUSIONS Our data reveal that the AAP healthy term newborn discharge recommendations are not consistently followed in our institution.
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Affiliation(s)
| | - Anne M Danicek
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan
| | - Rachel R Osborn
- Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, Michigan; and
| | - Sarah Q Fried
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan
| | - Olivia R Negris
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan
| | - Karson Lychuk
- College of Arts and Sciences, Loyola University Chicago, Chicago, Illinois
| | - Kerry P Mychaliska
- Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, Michigan; and
| | - Maria S Skoczylas
- Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, Michigan; and
| | - Kimberly K Monroe
- Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, Michigan; and
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26
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Yanıkkerem E, Esmeray N, Karakuş A, Üstgörül S, Baydar Ö, Göker A. Factors affecting readiness for discharge and perceived social support after childbirth. J Clin Nurs 2018; 27:2763-2775. [DOI: 10.1111/jocn.14248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Emre Yanıkkerem
- Faculty of Health Science Obstetrics and Gynecology Nursing Department Manisa Celal Bayar University Manisa Turkey
| | - Nicole Esmeray
- Faculty of Health Science Obstetrics and Gynecology Nursing Department Manisa Celal Bayar University Manisa Turkey
| | - Aslı Karakuş
- Faculty of Health Science Obstetrics and Gynecology Nursing Department Manisa Celal Bayar University Manisa Turkey
| | - Sema Üstgörül
- Faculty of Health Science Obstetrics and Gynecology Nursing Department Manisa Celal Bayar University Manisa Turkey
| | - Özge Baydar
- Faculty of Health Science Obstetrics and Gynecology Nursing Department Manisa Celal Bayar University Manisa Turkey
| | - Aslı Göker
- Faculty of Medicine Obstetrics and Gynecology Department Manisa Celal Bayar University Hafsa Sultan Hospital Manisa Turkey
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27
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Vikström A, Johansson S, Barimani M. Postnatal
ER
visits within 30 days—Pattern, risk factors and implications for care. J Clin Nurs 2017; 27:769-776. [DOI: 10.1111/jocn.14090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Anna Vikström
- The Division of Family Medicine Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
| | - Sven‐Erik Johansson
- The Division of Family Medicine Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
| | - Mia Barimani
- Division of Reproductive Health Department of Women′s and Children′s Health Karolinska Institutet Stockholm Sweden
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28
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Abstract
PURPOSE OF REVIEW The review highlights the shift from prescribed length of stay (LOS) to mother-infant dyad readiness as the basis for making discharge decisions for healthy term newborns. We describe the components of readiness that should be considered in making the decision, focusing on infant clinical readiness, and maternal and familial readiness. RECENT FINDINGS Although the Newborns' and Mothers' Health Protection Act of 1996 aimed to protect infants and mothers by establishing a minimum LOS, the American Academy of Pediatrics 2015 policy on newborn discharge acknowledges the shift from LOS-based to readiness-based discharge decision-making. Healthcare providers must consider a variety of infant and maternal characteristics in determining the appropriate time to discharge a dyad, and mothers should be actively involved in the decision-making process. Criteria for infant clinical readiness include the following: establishment of effective feeding, evaluation of jaundice risk, review and discussion of infant and household vaccination status, obtainment of specimen for metabolic screening, tests of hearing ability, assessment of sepsis risk factors, screening for congenital heart disease, and evaluation of parental knowledge about infant safety measures. Important consideration should also be given to the mother's sociodemographic vulnerabilities, maternal confidence and perception of discharge readiness, and availability of postdischarge care continuity. SUMMARY The timing of newborn discharge should be a joint decision made by the mother and healthcare providers based on readiness. The decision should consider the infant's health status, the mother's health status, the mother's perception of readiness, and the availability of social and familial support for the mother and infant. Accessible and comprehensive support postdischarge is also important for helping infants achieve optimal health outcomes.
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Abstract
BACKGROUND Standardized late preterm infant (LPI) discharge criteria ensure best practice and help guide the neonatal provider to determine the appropriate level of care following birth. However, the location can vary from the well newborn setting to the neonatal intensive care unit (NICU). PURPOSE The purpose of this review is to examine differences in LPI discharge criteria between the well newborn setting and the NICU by answering the clinical questions, "What are the recommended discharge criteria for the LPI and do they differ if admitted to the well newborn setting versus the NICU?" SEARCH STRATEGY Databases searched include CINAHL, TRIP, PubMed, and the Cochrane Library. Focusing first on the highest level of evidence, position statements, policy statements, and clinical practice guidelines were reviewed, followed by original research. RESULTS There were few differences shown between settings. Discharge criteria included physiological stability and completed screenings for hearing loss, hyperbilirubinemia, car seat safety, hypoglycemia, critical congenital heart disease, and sepsis. Parent education is provided on umbilical cord care, feeding, elimination, and weight gain norms. Recommended maternal assessment included screenings for depression, drug use, safe home environment, and presence of social support. In general, research supported protecting the mother-infant dyad. IMPLICATIONS FOR PRACTICE AND RESEARCH Developing a standardized approach for discharge criteria for LPIs may improve outcomes and reduce maternal stress. Research is needed to compare health and cost outcomes between settings.Video Abstract available at http://links.lww.com/ANC/A29.
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Harvey EM, Ahmed S, Manning SE, Diop H, Argani C, Strobino DM. Severe Maternal Morbidity at Delivery and Risk of Hospital Encounters Within 6 Weeks and 1 Year Postpartum. J Womens Health (Larchmt) 2017; 27:140-147. [PMID: 28953424 DOI: 10.1089/jwh.2017.6437] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about the impact of severe maternal morbidity (SMM) after delivery. We examined the risk of rehospitalization in the first year postpartum among deliveries to women with and without SMM. MATERIALS AND METHODS We used the Pregnancy to Early Life Longitudinal data system, in which vital birth/fetal death records were linked with hospital delivery discharge data and subsequent nondelivery hospitalization data, including observational stays (OSs) and in-patient stays (hospital discharge [HD]) for Massachusetts residents during 2002-2011. We excluded deliveries to women with preexisting chronic conditions: hypertension, diabetes, asthma, and autoimmune conditions for a final sample of 685,228 deliveries. Multivariable log binomial regression with generalized estimating equations modeled the relative risk (RR) of hospital encounters 6 weeks and 1 year postpartum. RESULTS The rate of SMM was 99 per 10,000 deliveries. In the first year postpartum, 2.8% of deliveries to women without chronic medical conditions experienced at least one HD encounter and 1.0% at least one OS encounter. The adjusted relative risk (aRR) of any HD encounter for deliveries with SMM was 2.48 (95% confidence interval [CI]: 2.20-2.80) within 6 weeks postpartum and 2.04 (95% CI: 1.87-2.23) within 1 year. For OS encounters, aRRs among deliveries with SMM at delivery were 2.47 (95% CI: 1.94-3.14) in the first 6 weeks and 1.69 (95% CI: 1.43-2.01) in 1 year. CONCLUSIONS In Massachusetts, SMM increased the risk of rehospitalization in the first year postpartum among deliveries to women without chronic medical conditions.
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Affiliation(s)
- Elizabeth M Harvey
- 1 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Saifuddin Ahmed
- 1 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Susan E Manning
- 2 Bureau of Family Health and Nutrition , Massachusetts Department of Public Health, Boston, Massachusetts.,3 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Hafsatou Diop
- 2 Bureau of Family Health and Nutrition , Massachusetts Department of Public Health, Boston, Massachusetts
| | - Cynthia Argani
- 4 Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Donna M Strobino
- 1 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
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Benahmed N, San Miguel L, Devos C, Fairon N, Christiaens W. Vaginal delivery: how does early hospital discharge affect mother and child outcomes? A systematic literature review. BMC Pregnancy Childbirth 2017; 17:289. [PMID: 28877667 PMCID: PMC5588709 DOI: 10.1186/s12884-017-1465-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 08/22/2017] [Indexed: 01/08/2023] Open
Affiliation(s)
- Nadia Benahmed
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Lorena San Miguel
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Carl Devos
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Nicolas Fairon
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Wendy Christiaens
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
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Khan A, Furtak SL, Melvin P, Rogers JE, Schuster MA, Landrigan CP. Parent-Provider Miscommunications in Hospitalized Children. Hosp Pediatr 2017; 7:505-515. [PMID: 28768684 DOI: 10.1542/hpeds.2016-0190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Miscommunications lead to medical errors and suboptimal hospital experience. Parent-provider miscommunications are understudied. OBJECTIVES (1) Examine characteristics of parent-provider miscommunications about hospitalized children, (2) describe associations among parent-provider miscommunications, parent-reported errors, and hospital experience, and (3) compare parent and attending physician reports of parent-provider miscommunications. METHODS Prospective cohort study of 471 parents of 0- to 17-year-old medical inpatients in a pediatric hospital between May 1, 2013 and October 1, 2014. At discharge, parents reported parent-provider miscommunication and type (selecting all applicable responses), overall experience, and errors during hospitalization. During discharge billing, the attending physicians (n = 52) of a subset of patients (n = 217) also reported miscommunications, enabling comparison of parent and attending physician reports. We used logistic regression to examine characteristics of parent-reported miscommunications; McNemar's test to examine associations between miscommunications, errors, and top-box (eg, "excellent") experience; and generalized estimating equations to compare parent- and attending physician-reported miscommunication rates. RESULTS Parents completed 406 surveys (86.2% response rate). 15.3% of parents (n = 62) reported miscommunications. Parents of patients with nonpublic insurance (odds ratio: 1.99; 95% confidence interval: 1.03-3.85) and longer lengths of stay (odds ratio: 1.12; 95% confidence interval: 1.02-1.23) more commonly reported miscommunications. Parents reporting miscommunications were 5.3 times more likely to report errors and 78.6% less likely to report top-box overall experience (P < .001 for both). Among patients with both parent and attending physician surveys, 16.1% (n = 35) of parents and 3.7% (n = 8) of attending physicians reported miscommunications (P < .001). Both parents and attending physicians attributed miscommunications most often to family receipt of conflicting information. CONCLUSIONS Parent-provider miscommunications were associated with parent-reported errors and suboptimal hospital experience. Parents reported parent-provider miscommunications more often than attending physicians did.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, .,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | | | | | - Jayne E Rogers
- Department of Nursing, Boston Children's Hospital, Boston, Massachusetts
| | - Mark A Schuster
- Division of General Pediatrics.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Christopher P Landrigan
- Division of General Pediatrics.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and.,Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Harron K, Gilbert R, Cromwell D, Oddie S, van der Meulen J. Newborn Length of Stay and Risk of Readmission. Paediatr Perinat Epidemiol 2017; 31:221-232. [PMID: 28418622 PMCID: PMC5518288 DOI: 10.1111/ppe.12359] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence on the association between newborn length of hospital stay (LOS) and risk of readmission is conflicting. We compared methods for modelling this relationship, by gestational age, using population-level hospital data on births in England between 2005-14. METHODS The association between LOS and unplanned readmission within 30 days of postnatal discharge was explored using four approaches: (i) modelling hospital-level LOS and readmission rates; (ii) comparing trends over time in LOS and readmission; (iii) modelling individual LOS and adjusted risk of readmission; and (iv) instrumental variable analyses (hospital-level mean LOS and number of births on the same day). RESULTS Of 4 667 827 babies, 5.2% were readmitted within 30 days. Aggregated data showed hospitals with longer mean LOS were not associated with lower readmission rates for vaginal (adjusted risk ratio (aRR) 0.87, 95% confidence interval (CI) 0.66, 1.13), or caesarean (aRR 0.89, 95% CI 0.72, 1.12) births. LOS fell by an average 2.0% per year for vaginal births and 3.4% for caesarean births, while readmission rates increased by 4.4 and 5.1% per year respectively. Approaches (iii) and (iv) indicated that longer LOS was associated with a reduced risk of readmission, but only for late preterm, vaginal births (34-36 completed weeks' gestation). CONCLUSIONS Longer newborn LOS may benefit late preterm babies, possibly due to increased medical or psychosocial support for those at greater risk of potentially preventable readmissions after birth. Research based on observational data to evaluate relationships between LOS and readmission should use methods to reduce the impact of unmeasured confounding.
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Affiliation(s)
- Katie Harron
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child HealthLondonUK
| | - David Cromwell
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sam Oddie
- Bradford NeonatologyBradford Royal InfirmaryBradfordUK
| | - Jan van der Meulen
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
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Enlow E, Faherty LJ, Wallace-Keeshen S, Martin AE, Shea JA, Lorch SA. Perspectives of Low Socioeconomic Status Mothers of Premature Infants. Pediatrics 2017; 139:peds.2016-2310. [PMID: 28223372 PMCID: PMC5330396 DOI: 10.1542/peds.2016-2310] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Transitioning premature infants from the NICU to home is a high-risk period with potential for compromised care. Parental stress is high, and families of low socioeconomic status may face additional challenges. Home visiting programs have been used to help this transition, with mixed success. We sought to understand the experiences of at-risk families during this transition to inform interventions. METHODS Mothers of infants born at <35 weeks' gestation, meeting low socioeconomic status criteria, were interviewed by telephone 30 days after discharge to assess caregiver experiences of discharge and perceptions of home visitors (HVs). We generated salient themes by using grounded theory and the constant comparative method. Interviews were conducted until thematic saturation was achieved. RESULTS Twenty-seven mothers completed interviews. Eighty-five percent were black, and 81% had Medicaid insurance. Concern about infants' health and fragility was the primary theme identified, with mothers reporting substantial stress going from a highly monitored NICU to an unmonitored home. Issues with trust and informational consistency were mentioned frequently and could threaten mothers' willingness to engage with providers. Strong family networks and determination compensated for limited economic resources, although many felt isolated. Mothers appreciated HVs' ability to address infant health but preferred nurses over lay health workers. CONCLUSIONS Low-income mothers experience significant anxiety about the transition from the NICU to home. Families value HVs who are trustworthy and have relevant medical knowledge about prematurity. Interventions to improve transition would benefit by incorporating parental input and facilitating trust and consistency in communication.
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Affiliation(s)
- Elizabeth Enlow
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; .,Division of Neonatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; and
| | - Laura J. Faherty
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; and,Robert Wood Johnson Foundation Clinical Scholars Program
| | | | - Ashley E Martin
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Judy A. Shea
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; and,Division of General and Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott A. Lorch
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Division of Neonatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;,Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; and
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Nilsson IMS, Kronborg H, Knight CH, Strandberg-Larsen K. Early discharge following birth - What characterises mothers and newborns? SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 11:60-68. [PMID: 28159130 DOI: 10.1016/j.srhc.2016.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 08/29/2016] [Accepted: 10/27/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Early postnatal discharge has increased over the past 50 years and today we lack the knowledge on who is discharged early that would allow us to improve quality of postnatal care. The aim of this study was to describe maternal and infant predictors for early postnatal discharge in a country with equal access to health care. METHODS An observational study of 2786 mothers, recruited in pregnancy was conducted from April 2013 to August 2014 in four of the five regions in Denmark. Data were analysed using Kaplan-Meier method and multinomial regression models. Outcome variable was time of discharge after birth. RESULTS In total 34% mothers were discharged within 12 hours (very early) and 25% between 13 and 50 hours (early), respectively. Vaginal birth and multiparity were the most influential predictors, as Caesarean section compared to vaginal birth had an OR of 0.35 (CI 0.26-0.48) and primiparous compared to multiparous had an OR of 0.22 (CI 0.17-0.29) for early discharge. Other predictors for early discharge were: no induction of labour, no epidural painkiller, bleeding less than 500 ml during delivery, higher gestational age, early expected discharge and positive breastfeeding experience. Smoking, favourable social support and breastfeeding knowledge were significantly associated with discharge within 12 hours. Finally time of discharge varied significantly according to region and time of day of birth. CONCLUSIONS Parity and birth related factors were the strongest predictors of early discharge. Psycho-social predictors indicate that the parents are involved in the decision of when to be discharge.
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Affiliation(s)
- Ingrid M S Nilsson
- The Danish Committee for Health Education, Copenhagen, Denmark; Department of Public Health, Section of Nursing, Aarhus University, Aarhus, Denmark; Department of Public Health, Section of Social Medicine, Copenhagen University, Copenhagen, Denmark.
| | - Hanne Kronborg
- Department of Public Health, Section of Nursing, Aarhus University, Aarhus, Denmark
| | - Christopher H Knight
- Institute of Veterinary Clinical and Animal Sciences, Copenhagen University, Copenhagen, Denmark
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Rochefort CM, Rathwell BA, Clarke SP. Rationing of nursing care interventions and its association with nurse-reported outcomes in the neonatal intensive care unit: a cross-sectional survey. BMC Nurs 2016; 15:46. [PMID: 27489507 PMCID: PMC4971656 DOI: 10.1186/s12912-016-0169-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence internationally suggests that staffing constraints and non-supportive work environments result in the rationing of nursing interventions (that is, limiting or omitting interventions for particular patients), which in turn may influence patient outcomes. In the neonatal intensive care unit (NICU), preliminary studies have found that discharge preparation and infant comfort care are among the most frequently rationed nursing interventions. However, it is unknown if the rationing of discharge preparation is related to lower perceptions of parent and infant readiness for NICU discharge, and if reports of increased rationing of infant comfort care are related to lower levels of perceived neonatal pain control. The purpose of this study was to assess these relationships. METHODS In late 2014, a cross-sectional survey was mailed to 285 Registered Nurses (RNs) working in one of 7 NICUs in the province of Quebec (Canada). The survey contained validated measures of care rationing, parent and infant readiness for discharge, and pain control, as well as items measuring RNs' characteristics. Multivariate regression was used to examine the association between care rationing, readiness for discharge and pain control, while adjusting for RNs' characteristics and clustering within NICUs. RESULTS Overall, 125 RNs completed the survey; a 44.0 % response rate. Among the respondents, 28.0 and 40.0 % reported rationing discharge preparation and infant comfort care "often" or "very often", respectively. Additionally, 15.2 % of respondents felt parents and infants were underprepared for NICU discharge, and 54.4 % felt that pain was not well managed on their unit. In multivariate analyses, the rationing of discharge preparation was negatively related to RNs' perceptions of parent and infant readiness for discharge, while reports of rationing of parental support and teaching and infant comfort care were associated with less favourable perceptions of neonatal pain control. CONCLUSIONS The rationing of nursing interventions appears to influence parent and infant readiness for discharge, as well as pain control in NICUs. Future investigations, in neonatal nursing care as well as in other nursing specialties, should address objectively measured patient outcomes (such as objective pain assessments and post-discharge outcomes assessed through administrative data).
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Affiliation(s)
- Christian M Rochefort
- School of Nursing, Faculty of Medicine, University of Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Room 200, Longueuil, Quebec J4K 0A8 Canada ; Centre de recherche, Hôpital Charles-LeMoyne, 150 Place Charles-LeMoyne, Room 200, Longueuil, Quebec J4K 0A8 Canada ; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2 Canada
| | - Bailey A Rathwell
- Ingram School of Nursing, McGill University, Wilson Hall, 3506 University Street, Montreal, Quebec H3A 2A7 Canada
| | - Sean P Clarke
- Ingram School of Nursing, McGill University, Wilson Hall, 3506 University Street, Montreal, Quebec H3A 2A7 Canada ; William F. Connell School of Nursing, Maloney Hall, Room 218, 140 Commonwealth Avenue, Chestnut Hill, MA 02467 USA ; McGill University Health Centre, Montréal, Canada
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Brittan M, Albright K, Cifuentes M, Jimenez-Zambrano A, Kempe A. Parent and Provider Perspectives on Pediatric Readmissions: What Can We Learn About Readiness for Discharge? Hosp Pediatr 2015; 5:559-65. [PMID: 26526801 DOI: 10.1542/hpeds.2015-0034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Readmissions are an increasingly recognized quality metric that will likely affect payments to children's hospitals. Our aim was to inform future efforts to reduce readmissions by eliciting parent and provider perceptions of pediatric readmissions. METHODS We interviewed English- and Spanish-speaking parents and inpatient providers of children with medical diagnoses who had unplanned readmissions (≤7 days). Parents were interviewed one-on-one during the readmission. Providers were interviewed in person or by phone within 1 week of the patient's second discharge. Interviewees were queried about their perceptions of the reason for readmission and whether the readmission was preventable. Interview transcripts were analyzed using qualitative content methods. Code categories were developed and emergent themes independently identified by 2 analysts. RESULTS The study included 30 readmitted children (median age 17 months, 70% male, 80% White or Hispanic, and 66% publically insured). We interviewed 30 parents (23% Spanish speaking) and 27 discharging or readmitting providers. Parents and providers identified several major factors as causing readmissions, including child related (health and symptoms), parent/family related (adherence to recommended care), provider/team related (medical management), communication difficulties, home supports, and quality of discharge teaching. Parents and providers had differing interpretations of the role or magnitude of these factors. Lack of shared understanding between parents and providers emerged as a potentially important cause of readmissions. CONCLUSIONS We identified lack of shared understanding and communication difficulties between parents and providers as potential causes of readmission. Further research is needed to determine if improvements in identifying and addressing such problems can reduce pediatric readmissions.
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Affiliation(s)
- Mark Brittan
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and
| | - Karen Albright
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Maribel Cifuentes
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Andrea Jimenez-Zambrano
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
| | - Allison Kempe
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and
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Smith VC, Hwang SS, Dukhovny D, Young S, Pursley DM. Neonatal intensive care unit discharge preparation, family readiness and infant outcomes: connecting the dots. J Perinatol 2013; 33:415-21. [PMID: 23492936 DOI: 10.1038/jp.2013.23] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Neonatal intensive care unit (NICU) discharge readiness is defined as the masterful attainment of technical skills and knowledge, emotional comfort, and confidence with infant care by the primary caregivers at the time of discharge. NICU discharge preparation is the process of facilitating comfort and confidence as well as the acquisition of knowledge and skills to successfully make the transition from the NICU to home. In this paper, we first review the literature about discharge readiness as it relates to the NICU population. Understanding that discharge readiness is achieved, in part, through successful discharge preparation, we then outline an approach to NICU discharge preparation.
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Affiliation(s)
- V C Smith
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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