Is follow-up care needed for short postpartum LOS?
Report says comprehensive services are necessary
Because of concerns over shorter lengths of stay (LOS) for postpartum patients and their newborns, follow-up services are becoming even more important.
A new federal report indicates that although discharging newborns less than 48 hours after birth appears to be safe, adequate follow-up care such as home health 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," with "mixed results" in studies on the risk of newborn readmissions. For example, studies done to date on the issue haven’t controlled for factors other than LOS that may contribute to readmission rates. A low readmission rate may be due to good postpartum care instead of length of stay. 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 in Washington, DC.
Guidelines specify short-stay criteria
Those guidelines 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 a documented ability of the mother to care for her baby.1,2
In general, the GAO report says that health plans and hospitals with short-stay policies that have early discharge programs including home visits by maternal and child health nurses within 48 to 72 hours after discharge 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 preterm birth, prepare women for short hospital stays, and provide prenatal education tend to have better outcomes as well, according to the report.
"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, . . . [and that] it is not always delivered in a timely manner by properly trained health care professionals."
[Editor’s note: To obtain 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.]
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.
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