Evaluation of an Early Discharge Program for Infants after Childbirth in a Military Population

Abstract

The objective of this study was to evaluate the outcome of an early discharge program for infants with regard to length of stay, patient safety, maternal satisfaction, and hospital expense in a military population. The study consisted of a retrospective analysis of data from two 6-month periods--March to August 1994 (before early discharge) and March to August 1996 (after early discharge)--in a military, tertiary care, teaching hospital. The criteria for early discharge included healthy term singleton newborns delivered by uncomplicated vaginal delivery with maternal support systems, transportation, and phone access. The interventions included maternal education regarding maternal and infant care and telephone follow-up at 48 hours and 5 days after discharge. The main outcome measures included length of hospital stay, inpatient cost, infant health services utilization, and maternal satisfaction (measured by survey). During the 6-month study periods in 1994 and 1996, a total of 1,911 deliveries were examined. The mean number (+/- SD) of hospital days per infant was 2.54 +/- 0.83 in 1994 compared with 1.88 +/- 1.03 in 1996. There was not a statistically significant difference in the number of readmissions between 1994 (9 of 1042, 0.86%) and 1996 (12 of 869, 1.38%) (odds ratio = 1.61, 95% confidence interval = 0.67, 3.83). A review of the infant health services utilization revealed a statistically significant increase in the total number of clinic visits (scheduled and unscheduled) before the 2-week well-child visit for the 1996 group. However, that group did not experience a change in the number of emergency room visits. Seventy-five percent of mothers were satisfied with the program as assessed by questionnaire. In addition, the program was able to save 599 inpatient hospital days, for a total cost savings of $442,903.23 in 1996. This reduction in inpatient hospital days netted an average cost savings of $509.67 per infant. By following strict discharge criteria, increasing parent education before discharge, implementing a phone follow-up system, and ensuring easy access to care, an early discharge program in our military population was not associated with increased adverse newborn outcomes and reduced costs.