Description and evaluation of a program for the early discharge of infants from a neonatal intensive care unit,☆☆,,★★

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Abstract

The effect of a cost-containment program focused on decreasing the lengths of hospital stay of high-risk neonates was assessed by comparison of discharge weights and lengths of stay for 257 study infants, discharged from a neonatal intensive care unit (NICU) after an early-discharge program began, with those of 477 control infants discharged during a prior 1-year period. Demographic data and costs, as well as data on emergency department use and hospital readmissions, were included in the comparisons. There was a significant decrease in mean discharge weight and length of stay for infants in the study group. During a 7-month period, an estimated 2073 days of hospital care and approximately $2,700,000 in hospital charges were saved, or $10,609 per infant discharged. The cost of instituting and maintaining the program was $120,413, or $468 per infant. Seven visits were made to the emergency department by the study infants during the first 14 days after discharge. One infant was readmitted for a 4-day hospital stay for suspected sepsis. Significantly earlier discharge of high-risk neonates produced a decrease in hospital charges without causing excessive morbidity. The success of the program was coincident and presumed related to the institution of multiple elements focused toward family support through early-discharge planning. The reduction in hospital charges was 30 times higher than program expenses. (J PEDIATR 1995;127:285-90)

Section snippets

Subjects

All patients discharged from the NICU at the University Hospital after June 1, 1993, were incorporated in the early discharge program. For detailed analyses, only data on patients discharged home from the unit before January 1, 1994, were used. These data were compared with those generated by a similar group of surviving infants selected from all infants discharged between April 1, 1992, and April 1, 1993, before program initiation. Early-discharge planning strategies were being tested during

Patient population

There were no significant differences in race and sex distributions, average birth weights, gestational ages, days in oxygen, days of ventilator use, or any of the other variables listed in Table I when infants discharged in the control and study periods were compared. Similarly, the percentages of infants who died, or of infants who survived to be transferred to other nurseries before discharge home, were not significantly different (Table I). There was no difference in birth weight

DISCUSSION

This report documents that infants in an inner city neonatal intensive care nursery can be discharged earlier and at lower body weights than previously was considered appropriate in the community. The difference in periods of study and control groups, however, does not eliminate the possibility of seasonal differences in outcome between groups. The reduction in hospital days was associated with a decrease in ancillary resource utilization, which is a significant contributor to the high cost of

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Cited by (0)

From the Pediatric Quality Outcomes Research Group, the Center for Clinical Effectiveness, and the Institute for Health Policy and Health Services Research, University of Cincinnati and Children's Hospital Medical Center, Cincinnati, Ohio

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Supported by Children's Hospital Research Foundation and the Institute for Health Policy and Health Services, University of Cincinnati, Cincinnati, Ohio.

Reprint requests: Uma R. Kotagal, MBBS, College of Medicine, Department of Pediatrics, University of Cincinnati, PO Box 670541, Cincinnati, OH 45267-0541.

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0022-3476/95/$3.00 + 0 9/23/65421

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