title: Neonatal intensive care unit census influences discharge of moderately preterm infants.
abstract: OBJECTIVE
  The timely discharge of moderately premature infants has important economic implications. The decision to discharge should occur independent of unit census. We evaluated the impact of unit census on the decision to discharge moderately preterm infants.
  
  
  METHODS
  In a prospective multicenter cohort study, we enrolled 850 infants born between 30 and 34 weeks' gestation at 10 NICUs in Massachusetts and California. We divided the daily census from each hospital into quintiles and tested whether discharges were evenly distributed among them. Using logistic regression, we analyzed predictors of discharge within census quintiles associated with a greater- or less-than-expected likelihood of discharge. We then explored parental satisfaction and postdischarge resource consumption in relation to discharge during census periods that were associated with high proportions of discharge.
  
  
  RESULTS
  There was a significant correlation between unit census and likelihood of discharge. When unit census was in the lowest quintile, patients were 20% less likely to be discharged when compared with all of the other quintiles of unit census. In the lowest quintile of unit census, patient/nurse ratio was the only variable associated with discharge. When census was in the highest quintile, patients were 32% more likely to be discharged when compared with all of the other quintiles of unit census. For patients in this quintile, a higher patient/nurse ratio increased the likelihood of discharge. Conversely, infants with prolonged lengths of stay, an increasing Score for Neonatal Acute Physiology II, and minor congenital anomalies were less likely to be discharged. Infants discharged at high unit census did not differ from their peers in terms of parental satisfaction, emergency department visits, home nurse visits, or rehospitalization rates.
  
  
  CONCLUSIONS
  Discharges are closely correlated with unit census. Providers incorporate demand and case mix into their discharge decisions.
authors.affiliation: Harvard Newborn Medicine Program, Children's Hospital Boston and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. profit@bcm.edu
authors.forename: Jochen
authors.initials: J
authors.lastname: Profit
authors.forename: Marie C
authors.initials: MC
authors.lastname: McCormick
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Escobar
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Richardson
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zheng
authors.forename: Kim
authors.initials: K
authors.lastname: Coleman-Phox
authors.forename: Rebecca
authors.initials: R
authors.lastname: Roberts
authors.forename: John A F
authors.initials: JA
authors.lastname: Zupancic
mesh_terms: D019352:Censuses; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies