Use of a comprehensive state birth data system to assess mother's satisfaction with length of stay

Postpartum Length of Stay and Hospital Readmission Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic

OBJECTIVE

To compare postpartum hospitalization length of stay (LOS) and hospital readmission among obstetric patients before (March 2017-February 2020; prepandemic) and during the coronavirus disease 2019 (COVID-19) pandemic (March 2020-February 2021).

METHODS

We conducted a retrospective cohort study, using Epic Systems' Cosmos research platform, of obstetric patients who delivered between March 1, 2017, and February 28, 2021, at 20-44 weeks of gestation and were discharged within 7 days of delivery. The primary outcome was short postpartum hospitalization LOS (less than two midnights for vaginal births and less than three midnights for cesarean births) and secondary outcome was hospital readmission within 6 weeks of postpartum hospitalization discharge. Analyses compared outcomes before and during the pandemic using standardized differences and Bayesian logistic mixed-effects models, among all births and stratified by mode of delivery.

RESULTS

Of the 994,268 obstetric patients in the study cohort, 742,113 (74.6%) delivered prepandemic and 252,155 (25.4%) delivered during the COVID-19 pandemic. During the COVID-19 pandemic, the percentage of short postpartum hospitalizations increased among all births (28.7-44.5%), vaginal births (25.4-39.5%), and cesarean births (35.3-55.1%), which was consistent with the adjusted analysis (all births: adjusted odds ratio [aOR] 2.35, 99% credible interval 2.32-2.39; vaginal births: aOR 2.14, 99% credible interval 2.11-2.18; cesarean births aOR 2.90, 99% credible interval 2.83-2.98). Although short postpartum hospitalizations were more common during the COVID-19 pandemic, there was no change in readmission in the unadjusted (1.4% vs 1.6%, standardized difference=0.009) or adjusted (aOR 1.02, 99% credible interval 0.97-1.08) analyses for all births or when stratified by mode of delivery.

CONCLUSION

Short postpartum hospitalization LOS was significantly more common during the COVID-19 pandemic for obstetric patients with no change in hospital readmissions within 6 weeks of postpartum hospitalization discharge. The COVID-19 pandemic created a natural experiment, suggesting shorter postpartum hospitalization may be reasonable for patients who are self-identified or health care professional-identified as appropriate for discharge.

Effect of an educational intervention on parental readiness for premature infant discharge from the neonatal intensive care units

AIM

To examine the effect of an educational intervention on parental readiness for premature infant discharge from neonatal intensive care units.

BACKGROUND

Low readiness for discharge can result in negative healthcare outcomes for infants and their parents. However, few studies have examined the effect of discharge education programmes on parental readiness for premature infant discharge in Chinese critical care settings.

DESIGN

A quasi-experimental study.

METHODS

Between October 2011-March 2012, 154 parents of premature infants were recruited from neonatal intensive care units of two tertiary hospitals in Central China. These parents were assigned to either the intervention or control group based on their entry order. Parents in the intervention group received two sessions of 60-minute discharge education along with hospital routine care; parents in the control group only received hospital routine care. Parental readiness for discharge and quality of discharge education were assessed on the day of infant discharge from neonatal intensive care units. Independent samples t-test and linear regression were used to analyse the data.

RESULTS

Parental readiness for premature infant discharge was in the moderate level. Independent samples t-test showed that both mean scores of parental discharge readiness and discharge teaching quality from the intervention group were significantly higher than those in the control group. Linear regression analysis showed that discharge teaching quality explained 39·7% of the variance in parental readiness for premature infant discharge.

CONCLUSION

Discharge education can improve parental readiness for premature infant discharge. Quality of discharge teaching can significantly predict parental readiness for premature infant discharge.

Time to listen: strategies to improve hospital-based postnatal care

BACKGROUND

In Australia and internationally, women report high levels of dissatisfaction with hospital-based postnatal care.

AIM

To design and implement strategies to improve hospital-based postnatal care at a Sydney metropolitan hospital.

METHOD

This was an Action Research study. In Phase One, midwives considered the literature and participated in group discussions and interviews to determine their perceptions of postnatal care and the factors that facilitate or hinder the provision of quality care. In Phase Two, midwives participated in 12 working group meetings to design strategies to improve care.

RESULTS

Several important principles of postnatal care were described, including building a relationship with women, meeting their individual needs, being flexible in approach and providing continuity of care. 'Listening to women', 'being there,' and 'normalising experiences and expectations' were believed to be critical to achieving these principles. A key strategy 'One to One Time' was designed to provide women with an uninterrupted period of time each day with a midwife who was available to listen to their needs and concerns and discuss issues related to their health and that of their baby.

CONCLUSION

Midwives designed and implemented strategies that they believed would improve in-hospital postnatal care.

Postnatal care in the community: report of an evaluation of birthing women's assessments of a postnatal home-care programme

For more than a decade, there has been a strong trend in many Western countries to decrease the length of time that women spend in hospital following childbirth. The research evidence regarding the consequences of early discharge for mothers and babies is mixed. Recent evidence has suggested that early discharge may not be randomly distributed across all sociodemographic groups of birthing women, and that the structures of home care have an important influence on maternal and child outcomes. In the context of decreasing lengths of hospital stay, the aim of the present study was to evaluate a new postnatal home support worker introduced into a geographically defined catchment area of a metropolitan hospital in South Australia. The evaluation included a formative process component to monitor recruitment strategies into the programme, as well as summative evaluation of a number of projected programme outcomes. The research methods used included interviews with antenatal women (n = 20) about their knowledge of and attitudes to the programme, and interviews with postnatal women (n = 63) about their transition home experience and assessment of the programme. Secondary analysis of client satisfaction surveys (n = 163) and aggregate breast-feeding data was also conducted. The results concur with previous research findings regarding the importance of rest and practical, home-based support in the postnatal period to maternal well-being, successful bonding and transition to motherhood. The results demonstrate the importance of well-structured home support services to maternal satisfaction and maternal well-being through the provision of physical, social and emotional care and support in the home.

Validity and Reliability of the Perceived Readiness for Discharge After Birth Scale

OBJECTIVE

To assess the psychometric properties of a scale measuring mothers' perceptions of readiness for discharge after birth.

DESIGN

Psychometric analyses including construct validity using factor analysis and known groups comparisons, predictive validity, and reliability. Data were collected at discharge and 6 weeks postdischarge.

SETTING

Tertiary-level perinatal center in the Midwestern United States.

PARTICIPANTS

1,462 postpartum mothers.

INTERVENTION

None.

MAIN OUTCOME MEASURES

Perceived Readiness for Discharge After Birth Scale scores; subscale scores for personal status and knowledge factors.

RESULTS

Exploratory and confirmatory factor analyses indicated that the scale contained two factors. Perceived Readiness for Discharge After Birth Scale scores were lower for mothers who were breastfeeding, married, primiparous, and had a short hospital stay (less than 30 hours) than for their comparison groups. The Perceived Readiness for Discharge After Birth Scale personal status factor was predictive of self-reported physical and psychosocial problems and unscheduled utilization of health services in the first 6 weeks postpartum. The knowledge factor was predictive of postdischarge telephone calls to the pediatric provider. Reliability estimates ranged from 0.83 to 0.89 for the total scale and subscales.

CONCLUSIONS

The Perceived Readiness for Discharge After Birth Scale performed well in psychometric testing. Assessing mothers' perceptions of readiness for discharge is important for measuring outcomes of hospitalization and for identifying mothers at risk for postdischarge problems.