A PROGRAM TO REDUCE DISCHARGE DELAYS IN AN NICU. 1412

Abstract

We wished to test the hypothesis that a program designed to identify the causes of discharge delays (DD) would significantly reduce the length of stay in our metropolitan academic regional NICU. We reviewed all admissions from January 1994 through November 1995 (n=1396). A DD was defined as any delay in discharge not related to illness after the attending neonatologist cleared the baby for release. DDs were further divided according to cause into medical, administrative, social work, family-related, and “other” categories. All admissions were reviewed by one of the authors. Potential DDs were identified and tracked daily according to established criteria. Actual DDs were then reviewed on a monthly basis at an open staff meeting attended by representatives our multi-disciplinary team. 111 DDs accounting for 481 patient days were identified, 83 DD/302 patient days in 1994 and 28 DD/179 patient days in 1995. 13.9% of DDs weighed <1000 gms. at birth, and 35.6% were <1500 gms. at birth. DDs ranged from 1-34 days, with an average of 4.3 days added/case. Babies with DDs had a case mix index (CMI) of 9.70. The average CMI for the NICU during 1994 was 6.25, and for 1995 to date was 5.18, with an overall average of 5.71 for the entire period. 44% of DDs had private insurance, 55% had Medicaid, and 1% were self-pay. 84/111 DDs were caused by circumstances beyond the control of the primary care team. A further 24/111 DDs were the result of our policy requiring a 48-hour period free of apnea/bradycardia alarms prior to discharge. Average savings per day were based on the diagnosis-related group (DRG) of each DD patient. Discharge delays for 1994 cost $226,298. ($749/day). For 1995, DDs cost $36,132($202/day), for a total cost of $262,431. Total savings in 1995 vs. 1994 was$190,166 ($548/day). Despite their low birth weight and relatively severe illness (high CMI), we believe that heightened staff awareness and ongoing monitoring of potential DDs can result in a significant reduction in length of stay and a significant cost savings.