A randomized trial of early hospital discharge and home follow-up of women having cesarean birth.
OBJECTIVE
To determine the safety, efficacy, and cost savings of early hospital discharge of women delivered by unplanned cesarean delivery.


METHODS
Using randomized assignment, 61 postpartum women were discharged from the hospital at the usual time, and 61 were discharged early and had nurse specialist home follow-up care. The latter group received comprehensive discharge planning, instruction, counseling, home visits, and daily on-call availability from the nurse specialists. Both groups were followed from delivery to 8 weeks postpartum.


RESULTS
Women who were discharged early and received transitional home care services by clinical nurse specialists were sent home a mean of 30.3 hours earlier than the control group (P < .001). They had significantly greater satisfaction with care, more of their infants had timely immunizations at the end of follow-up, and they had a 29% reduction in health care charges compared to the control group receiving routine care. Although there were no statistically significant differences in maternal and infant rehospitalizations and acute-care visits, there were more maternal rehospitalizations in the control group than in the nurse specialist-followed group (three versus zero). No statistically significant differences were found between the groups in the outcomes of maternal affect and overall functional status.


CONCLUSIONS
Early hospital discharge of women after unplanned cesarean birth, using the model of nurse specialist transitional home care, is safe, feasible, and cost-effective.
Brooten
D
D
Center for Low Birthweight Research, University of Pennsylvania, School of Nursing.
Roncoli
M
M
Finkler
S
S
Arnold
L
L
Cohen
A
A
Mennuti
M
M
D000328:Adult; D002585:Cesarean Section / Q000191:economics; D003365:Costs and Cost Analysis; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000191:economics; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay; D010351:Patient Discharge; D010359:Patient Readmission; D011247:Pregnancy