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Groening P, Silver EJ, Nemerofsky SL. Decreasing the Newborn Birth Hospitalization Length of Stay. Am J Perinatol 2024; 41:e1362-e1367. [PMID: 36724873 DOI: 10.1055/a-2024-1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study aimed to determine our ability to shorten birth hospitalization length of stay (LOS) in which patient characteristics were associated with early discharge and had effects on early newborn readmission rate. STUDY DESIGN Retrospective chart review of births from April 1, 2020 to December 31, 2020, was considered for this study. Delivery mode and maternal and newborn characteristics were evaluated for effect on discharge timing. Hospital readmissions within 7 days of discharge were reviewed. RESULTS In total, 845 out of 1,077 total live births were included in the study population. Five hundred and eighty-nine (69.7%) newborns were discharged early (<48 hours after vaginal delivery [VD] and <72 hours after cesarean delivery [CS]). Factors associated with early discharge included 79.8% CS (p < 0.001), 84% birth after 2 p.m. (p < 0.001), 71.2% no diagnosis of maternal diabetes (p = 0.02), and 70.6% negative maternal coronavirus disease 2019 (p = 0.01). The overall 7-day readmission rate was 1.2 and 0.5% for newborns discharged early after VD. CONCLUSION Most newborns can be discharged early without increasing newborn readmission. KEY POINTS · Most patients were discharged <72 hours after CS.. · Most patients were discharged <48 hours after VD.. · Early discharge does not affect newborn readmissions..
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Affiliation(s)
- Portia Groening
- Albert Einstein College of Medicine, Bronx, New York
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | | | - Sheri L Nemerofsky
- Albert Einstein College of Medicine, Bronx, New York
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
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Kokab F, Jones E, Goodwin L, Taylor B, Kenyon S. Community midwives views of postnatal care in the UK; A descriptive qualitative study. Midwifery 2021; 104:103183. [PMID: 34808526 DOI: 10.1016/j.midw.2021.103183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore views and experiences of community midwives delivering postnatal care. DESIGN A descriptive qualitative study design undertaking focus groups with community midwives and community midwifery team leaders. SETTING All focus groups were carried out in community midwifery care settings, across four hospitals in two NHS organisations, April to June 2018 in the West Midlands, UK. PARTICIPANTS 47 midwives: 34 community midwives and 13 community midwifery team leaders took part in 7 focus groups. FINDINGS Inductive framework analysis of data led to the development of themes and sub-themes relating to factors influencing discharge from hospital, strategies to address increases in discharge and the broader challenges to providing care. Conditions on the postnatal ward and women's experiences of care in the hospital were factors influencing timing of discharge from hospital that resulted in community midwives managing women and babies with more complex needs. In order to manage increased workloads, there was growing but varied use of flexible approaches to providing care such as telephone consultations, postnatal clinics, and maternity support workers. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE In a context of short postnatal hospital stays, community midwives appear to be responding to women's needs and service pressures in the postnatal period. Wider implementation of specific strategies to organise and deliver support to women and babies may further improve care and outcomes.
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Affiliation(s)
- Farina Kokab
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Eleanor Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Laura Goodwin
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
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Determinants of length of stay after cesarean sections in the Friuli Venezia Giulia Region (North-Eastern Italy), 2005-2015. Sci Rep 2020; 10:19238. [PMID: 33159096 PMCID: PMC7648096 DOI: 10.1038/s41598-020-74161-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
Since Italy has the highest cesarean section (CS) rate (38.1%) among all European countries, the containment of health care costs associated with CS is needed, along with control of length of hospital stay (LOS) following CS. This population based cross-sectional study aims to investigate LoS post CS (overall CS, OCS; planned CS, PCS; urgent/emergency CS, UCS), in Friuli Venezia Giulia (a region of North-Eastern Italy) during 2005–2015, adjusting for a considerable number factors, including various obstetric conditions/complications. Maternal and newborn characteristics (health care setting and timeframe; maternal health factors; child’s size factors; child’s fragility factors; socio-demographic background; obstetric history; obstetric conditions) were used as independent variables. LoS (post OCS, PCS, UCS) was the outcome measure. The statistical analysis was conducted with multivariable linear (LoS expressed as adjusted mean, in days) as well as logistic (adjusted proportion of LoS > 4 days vs. LoS ≤ 4 days, using a 4 day cutoff for early discharge, ED) regression. An important decreasing trend over time in mean LoS and LoS > ED was observed for both PCS and UCS. LoS post CS was shorter with parity and history of CS, whereas it was longer among non-EU mothers. Several obstetric conditions/complications were associated with extended LoS. Whilst eclampsia/pre-eclampsia and preterm gestations (33–36 weeks) were predominantly associated with longer LoS post UCS, for PCS LoS was significantly longer with birthweight 2.0–2.5 kg, multiple birth and increasing maternal age. Strong significant inter-hospital variation remained after adjustment for the major clinical conditions. This study shows that routinely collected administrative data provide useful information for health planning and monitoring, identifying inter-hospital differences that could be targeted by policy interventions aimed at improving the efficiency of obstetric care. The important decreasing trend over time of LoS post CS, coupled with the impact of some socio-demographic and obstetric history factors on LoS, seemingly suggests a positive approach of health care providers of FVG in decision making on hospitalization length post CS. However, the significant role of several obstetric conditions did not influence hospital variation. Inter-hospital variations of LoS could depend on a number of factors, including the capacity to discharge patients into the surrounding non-acute facilities. Further studies are warranted to ascertain whether LoS can be attributed to hospital efficiency rather than the characteristics of the hospital catchment area.
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Li AHT, Palmer KS, Taljaard M, Paterson JM, Brown A, Huang A, Marani H, Lapointe-Shaw L, Pincus D, Wettstein MS, Kulkarni GS, Wasserstein D, Ivers N. Effects of quality-based procedure hospital funding reform in Ontario, Canada: An interrupted time series study. PLoS One 2020; 15:e0236480. [PMID: 32813687 PMCID: PMC7437861 DOI: 10.1371/journal.pone.0236480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 07/07/2020] [Indexed: 11/19/2022] Open
Abstract
Background The Government of Ontario, Canada, announced hospital funding reforms in 2011, including Quality-based Procedures (QBPs) involving pre-set funds for managing patients with specific diagnoses/procedures. A key goal was to improve quality of care across the jurisdiction. Methods Interrupted time series evaluated the policy change, focusing on four QBPs (congestive heart failure, hip fracture surgery, pneumonia, prostate cancer surgery), on patients hospitalized 2010–2017. Outcomes included return to hospital or death within 30 days, acute length of stay (LOS), volume of admissions, and patient characteristics. Results At 2 years post-QBPs, the percentage of hip fracture patients who returned to hospital or died was 3.13% higher in absolute terms (95% CI: 0.37% to 5.89%) than if QBPs had not been introduced. There were no other statistically significant changes for return to hospital or death. For LOS, the only statistically significant change was an increase for prostate cancer surgery of 0.33 days (95% CI: 0.07 to 0.59). Volume increased for congestive heart failure admissions by 80 patients (95% CI: 2 to 159) and decreased for hip fracture surgery by 138 patients (95% CI: -183 to -93) but did not change for pneumonia or prostate cancer surgery. The percentage of patients who lived in the lowest neighborhood income quintile increased slightly for those diagnosed with congestive heart failure (1.89%; 95% CI: 0.51% to 3.27%) and decreased for those who underwent prostate cancer surgery (-2.08%; 95% CI: -3.74% to -0.43%). Interpretation This policy initiative involving a change to hospital funding for certain conditions was not associated with substantial, jurisdictional-level changes in access or quality.
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Affiliation(s)
- Alvin Ho-ting Li
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- * E-mail:
| | - Karen S. Palmer
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - J. Michael Paterson
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Adalsteinn Brown
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anjie Huang
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Husayn Marani
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Daniel Pincus
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Marian S. Wettstein
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology (Urology), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Girish S. Kulkarni
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Surgical Oncology (Urology), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Wasserstein
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Noah Ivers
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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