Academic journal article Canadian Journal of Public Health

Early Discharge of Alberta Mothers Post-Delivery and the Relationship to Potentially Preventable Newborn Readmissions

Academic journal article Canadian Journal of Public Health

Early Discharge of Alberta Mothers Post-Delivery and the Relationship to Potentially Preventable Newborn Readmissions

Article excerpt

ABSTRACT

Objective: To determine whether early maternal discharge increases newborn readmission rates.

Methods: Singleton vaginal deliveries weighing at least 2500 grams were extracted from April 1, 1997 to March 31, 2000 Alberta hospital abstracts and linked to records of birth. Potentially preventable readmissions were for dehydration, jaundice, feeding problems, inadequate weight gain, and social reasons.

Results: The most common reason for readmission is jaundice (74%). In order of importance, influencing factors were: length of gestation, Aboriginal treaty status, first live birth, delivering in region of residence, number of deliveries done in the hospital, newborn sex, maternal smoking, birthweight, previous abortions, and delivering in nearest hospital. Post-delivery length of stay was associated with readmissions in the first 6 days post discharge (25% greater in those <27 hours compared to those >48 hours) but not in the first 28 days post discharge.

Conclusion: Early maternal discharge is a minor determinant of potentially preventable newborn readmissions.

The Canadian Pediatric Society and the Society of Obstetrics and Gynecologists of Canada recommend that a hospital stay of 12 to 48 hours is adequate for women and their newborns in absence of medical illness and in the presence of social support.1 The length of hospital stay after vaginal delivery has decreased in Canada from 4.7 days in 1984/85 to 2.6 days in 1994/95.2 A recent study in one Ontario hospital suggests that the successful adoption of a clinical pathway increasing early hospital discharge worsened newborn readmission rate.3 Earlier maternal discharge in Ontario has been associated with increased newborn readmissions for jaundice and dehydration in that province.4 The march to progressively earlier discharge (12 to 24 hours) in the early 1990s resulted in both physicians5-7 and mothers8 stating that maternal and newborn well-being may be worse because of less time spent in hospital after delivery. Population-based, retrospective studies in the United States differ in their conclusions regarding the effect of early maternal discharge upon newborn readmissions.9,10

If earlier hospital discharge post-delivery is associated with increased newborn readmissions, the benefits of early discharge are lessened. The possible association of early discharge and increased newborn readmission (especially those potentially preventable such as for jaundice or dehydration) may be organization-specific varying between hospitals. Conversely, newborn readmission may be more strongly associated with maternal factors such as race, age, personal habits, socio-economic status, or social support. In this study, we assess the effect of early maternal discharge after singleton vaginal delivery of newborns weighing 2500 grams or more upon potentially preventable newborn readmissions within 28 days of maternal discharge.

METHODS

Three Alberta administrative health service databases were used.

* Canadian Institute for Health Information's (CIHI) Inpatient Discharge Abstract Database (DAD) for 1997/98 to 1999/2000,

* Vital Statistics Birth Database for 19971999, and

* Health Insurance Plan Registry File for 1997 to 2000.

Identifying the maternal delivery

Maternal deliveries were identified using CIHI DAD (Discharge Abstract Database). Over 99% of the births that occur in Alberta take place in acute care facilities. All separations with a Main Patient Service area = 51 (obstetrics delivered) were extracted. Three years of data were combined because the volume of deliveries in some hospitals was small. No stillbirths were included.

Identifying the neonatal birth

Main patient service field = 54 (newborn) was extracted from CIHI DAD. The Alberta Health Care Insurance Plan registry file group number was used to match each newborn to each mother and to determine multiple births. …

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