Does family-centred neonatal discharge planning reduce healthcare usage? A before and after study in South West England. Issue 3 (10th March 2016)

• Record Type: Journal Article
• Authors: Ingram, Jenny C; Powell, Jane E; Blair, Peter S; Pontin, David; Redshaw, Maggie; Manns, Sarah; Beasant, Lucy; Burden, Heather; Johnson, Debbie; Rose, Claire; Fleming, Peter J
• Is Part Of: BMJ open. Volume 6:Issue 3(2016)
• Publication Date: 2016-03-10
• Subjects: Neonatal care -- family-centred -- self-efficacy -- discharge planning; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2015-010752
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : 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. 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.