Does family-centred neonatal discharge planning reduce healthcare usage? A before and after study in South West England

• Published in: BMJ open Vol. 6; no. 3; p. e010752
• Main 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
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 10.03.2016; BMJ Publishing Group
• Subjects: Adult; Ambulatory Care Facilities - statistics & numerical data; Birth weight; Confidence; Cost control; Data collection; Discharge planning; England; Families & family life; Female; Focus groups; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal - statistics & numerical data; Length of Stay; Male; Newborn babies; Paediatrics; Parents & parenting; Parents - education; Patient Discharge; Premature babies; United Kingdom > UK; England; discharge planning; Neonatal care; family-centred; self-efficacy
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2015-010752

ObjectiveTo implement parent-oriented discharge planning (Train-to-Home) for preterm infants in neonatal care.DesignBefore and after study, investigating the effects of the intervention during two 11-month periods before and after implementation.SettingFour local neonatal units (LNUs) in South West England.ParticipantsInfants without major anomalies born at 27–33 weeks’ gestation admitted to participating units, and their parents.Train-to-Home interventionA 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 measuresPerceived Maternal Parenting Self-Efficacy (PMP S-E) scores, infant length of stay (LOS) and healthcare utilisation for 8 weeks following discharge.ResultsParents 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.ConclusionsDespite 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.