Does family-centred neonatal discharge planning reduce healthcare usage?

Ingram, J.C. et al. BMJ Open 2016;6:e010752

Objective To implement parent-oriented discharge planning (Train-to-Home) for preterm infants in neonatal care.

Design Before and after study, investigating the effects of the intervention during two 11-month periods before and after implementation.

Setting Four local neonatal units (LNUs) in South West England.

Participants Infants without major anomalies born at 27–33 weeks’ gestation admitted to participating units, and their parents.

Train-to-Home intervention A family-centred discharge package to increase parents’ involvement and understanding of their baby’s needs, comprising a train graphic and supporting care pathways to facilitate parents’ understanding of their baby’s progress and physiological maturation, combined with improved estimation of the likely discharge date.

Image source: Ingram, J.C. et al. in BMJ Open.

Main outcome measures Perceived Maternal Parenting Self-Efficacy (PMP S-E) scores, infant length of stay (LOS) and healthcare utilisation for 8 weeks following discharge.

Results Parents reported that the Train-to-Home improved understanding of their baby’s progress and their preparedness for discharge. Despite a lack of change in PMP S-E scores with the intervention, the number of post-discharge visits to emergency departments (EDs) fell from 31 to 20 (p<0.05), with a significant reduction in associated healthcare costs (£3400 to £2200; p<0.05) after discharge. In both study phases, over 50% of infants went home more than 3 weeks before their estimated date of delivery (EDD), though no reduction in LOS occurred.

Conclusions Despite the lack of measurable effect on the parental self-efficacy scores, the reduction in ED attendances and associated costs supports the potential value of this approach.

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