Effect of implementation of an early hospital discharge policy on the readmission rates of neonates born by uncomplicated vaginal delivery: matched cohort study with historical controls
Abstract
Background. In August 2011, Davao Regional Hospital started to implement an early hospital discharge policy (within 48 hours after delivery) for term neonates born by uncomplicated vaginal delivery, with normal physical findings, good suck, urine output, and stool output.
Objective. To compare the readmission rates before and after the implementation of an early hospital discharge policy among neonates.
Design. Matched cohort study with historical controls.
Setting. Davao Regional Hospital in Tagum City, Philippines.
Participants. 1,960 term neonates born by uncomplicated vaginal delivery.
Main outcome measures. Readmission rates before and after implementation of an early hospital discharge policy, odds ratios (95% CI) of readmission for selected clinical characteristics of neonates.
Main results. There were 980 neonates prior to policy implementation and another 980 neonates after policy implementation who were included in the analysis. Neonates in the pre-implementation and post-implementation groups were comparable in terms of gestational age (39±1 weeks and 39±1 weeks, respectively; p=0.215) and sex distribution (male to female ratios 510:470 and 517:463, respectively; p=0.752). There were 18 (1.8%) readmissions in the pre-implementation group and 49 (5%) in the post-implementation group (p>0.001). A hospital stay of less than 24 hours significantly increased the odds of readmission (OR=1.8; 95% CI 1.1 to 3.1).
Conclusion. The readmission rate of neonates was higher after the implementation of an early (less than 48 hours after delivery) hospital discharge policy. Discharging neonates before 24 hours of life increased the odds ratio of readmission.
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