Early discharge revisited: problems encountered with the home visit follow-up after the liberalization of eligibility criteria.
OBJECTIVE
To determine how changes in eligibility criteria for early discharge affected quality and costs of home nursing follow-up care for Medicaid patients.


METHODS
A nurse screened women delivering vaginally to determine eligibility for discharge at 24-47 h. Maternal criteria were a vaginal delivery, no serious medical problems, > or = 8 h after bilateral tubal ligation and, if 24 h postpartum, by 21.00 on day of discharge. Newborn criteria were 36 weeks' gestation or more, 2000 g or greater and a normal examination at 24 h of age. By 48 h after discharge, a nursing visit was ordered for each mother and newborn. Nursing consultations were tracked and later entered into a database linked to hospital financial data.


RESULTS
Of 3133 vaginal deliveries occurring from 1 August 1997 to 31 January 1999, eligibility criteria allowed 1799 mothers (58%) and 1587 newborns (51%) to be discharged early. Medical problems were rarely detected at follow-up (1% mothers, 2% newborns). To perform the increased number of visits, more personnel were hired and home nursing costs rose 150%. Despite the increased staff and costs, 19 mothers (1%) and ten newborns (0.6%) were lost to follow-up and 25 mothers (1%) and 20 newborns (1%) were visited beyond 72 h after discharge.


CONCLUSIONS
Liberal changes in maternal and newborn eligibility criteria did not adversely affect the quality of home nursing follow-up care following early discharge. For hospitals performing a large number of early discharges, follow-up care using only a home nursing visit may be too expensive and difficult to organize. Alternative follow-up plans, such as clinic visits or phone calls, may also need to be utilized.
Brumfield
C G
CG
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA.
Ashworth
C S
CS
Lea
C
C
Sims
J
J
Yarbaugh
D
D
Cliver
S P
SP
D000293:Adolescent; D000328:Adult; D000407:Alabama; D036861:Delivery, Obstetric; D004608:Eligibility Determination; D005260:Female; D005865:Gestational Age; D017048:Health Care Costs; D018575:Home Care Services, Hospital-Based / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008484:Medicaid; D010351:Patient Discharge; D011247:Pregnancy; D011787:Quality of Health Care