Is follow-up warranted for short postpartum stay?
June 1, 1998 3 minutes read
Is follow-up warranted for short postpartum stay?
GAO: Comprehensive services necessary
Because of concerns over shorter lengths of stay (LOS) for postpartum patients and their newborns, follow-up services are becoming more important. A new federal report notes that while discharging newborns fewer than 48 hours after birth appears to be safe, adequate follow-up care is essential to successful early discharge.
The report, issued by the U.S. General Accounting Office (GAO) in Washington, DC, found that 39.8% of newborns born in 1994 had an average LOS of one day or less, compared to only 8.9% in 1980. But evidence of any adverse effects on newborns or mothers from short stays is inconclusive and mixed in studies on the risk of newborn readmissions. A low readmission rate may be due to good postpartum care instead of shortened LOS. In addition, many complications in newborns can't be detected reliably until 72 hours after birth, so a longer LOS may not necessarily be the answer to the problem of readmissions.
The GAO recommends that hospitals follow 1995 recommendations from the American Association of Pediatrics and the American College of Obstetricians and Gynecologists. These recommendations advocate that mothers and newborns be hospitalized until certain medical criteria are met, such as absence of medical complications, completion of at least two successful feedings, and documentation of the mother's ability to care for her baby.1,2 The GAO report says health plans and hospitals with short-stay policies and early discharge programs have had the greatest patient satisfaction and outcomes with fewer readmissions for both mothers and infants. In addition, health plans with prenatal programs that screen for risk factors for pre-term birth, prepare women for short hospital stays, and provide prenatal education tend to have better outcomes as well.
"Discharging mothers and babies after a postpartum stay of less than 48 hours appears to be safe in those cases where the policy is selectively and flexibly applied to uncomplicated vaginal deliveries and where proper follow-up services are provided," the GAO concludes. "[But] there is evidence that women and newborns are being discharged early without much follow-up care . . . it is not always delivered in a timely manner by properly trained health care professionals."
Early discharge no link to jaundice
A study by the University of California at San Francisco (UCSF) and Kaiser Permanente added fuel to the debate when it found that early discharge of newborns from the hospital, even in fewer than 24 hours, is not linked to an increase in the occurrence of extreme newborn jaundice. The report was presented at last year's meeting of the Pediatric Academic Societies in Washington, DC.
The UCSF-Kaiser study reviewed data from 34,840 infants over a 16-month period. The infants were born at 11 Kaiser Permanente Hospitals in Northern California between January 1995 and April 1996 with birth weights of 4.4 or more pounds. Although 33% of the infants in the study were released after less than 24 hours, only 54 infants, or .14%, had extreme hyperbilirubinemia or jaundice.
References
1. American College of Obstetricians and Gynecologists Committee on Obstetrics. Guidelines for Perinatal Care. Washington, DC: 1992.
2. American Association of Pediatrics Committee on the Fetus and Newborn. Hospital stay for healthy-term newborns. Pediatrics 1995; 96:788-790.
[Editor's note: For a free copy of the report Maternity Care: Appropriate Follow-Up Services Critical With Short Hospital Stays, contact: U.S. General Accounting Office, P.O. Box 6015, Gaithersburg, MD 20884-6015. Telephone: (202) 512-6000. Fax: (301) 258-4066.]
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