ARE NURSES HOME VISITS A SOLUTION TO THE PROBLEM OF EARLY DISCHARGES AMONG INNER CITY DELIVERIES? † 642

Abstract

In order to contain medical costs many insurance companies have advocated 24 hour discharges of postpartum mothers and newborn infants followed by a nurses home visit within 48 hours of discharge. We hypothesized that such an approach would not work in our inner city population because many of the addresses given by our mothers are false and therefore, these mothers and babies may not be found. We were also concerned about the safety of such visits. In order to test that hypothesis we reviewed the records of all Maternal Child Health Referrals in 1995 to the Visiting Nurse Service of New York for Bronx, N.Y. A total of 8,419 patients were referred and 7,035 visits were successful (84%). Of the 1,384 unsuccessful visits, 480 (35%) were because the patient could not be found, 265 (19%) were because the patient/family refused care, 80 (6%) because the family moved, 3 were because the visit was thought not to be safe and 628 (45%) were because of other technical problems. To evaluate a poor inner city population we reviewed the records for Bronx Lebanon Hospital. Among 1958 patients referred, 1644 were successful (84%) and 314 unsuccessful. 160 (33%) could not be found, 71 (23%) were because of refusal of care, 14 (4%) because the family moved, and 2 because of safety. We conclude that nursing home visits are successful in at least 84% of newborn infants and therefore, early discharges may be possible in the majority of deliveries even in an inner city population. We hypothesize that a single antenatal nursing home visit would help to identify those families who could have a successful post-discharge home visit.