title: From hospital to home: the quality and safety of a postnatal discharge system used for remote dwelling Aboriginal mothers and infants in the top end of Australia.
abstract: OBJECTIVE
  to examine the transition of care in the postnatal period from a regional hospital to a remote health service and describe the quality and safety implications for remote dwelling Aboriginal mothers and infants.
  
  
  METHODS
  a retrospective cohort study of maternal health service utilisation and birth outcomes, key informant interviews with health service providers and participant observation in a hospital and two remote health centres. Data were analysed using descriptive statistics and content analysis.
  
  
  METHODS
  a maternity unit in a regional public hospital and two remote health centres within large Aboriginal communities in the Top End of the Northern Territory, Australia.
  
  
  RESULTS
  poor discharge documentation, communication and co-ordination between hospital and remote health centre staff occurred. In addition, the lack of clinical governance and a specific position holding responsibility for the postnatal discharge planning process in the hospital system were identified as serious risks to the safety of the mother and infant.
  
  
  CONCLUSIONS
  the quality and safety of discharge practices for remote dwelling mothers and their infants in the transition from hospital to their remote health service following birth need to be improved. The discharge process and service delivery model must be restructured to reduce the adverse effects of poor standards of care on mothers and infants.
authors.affiliation: Northern Rivers Department of Rural Health, School of Public Health, Faculty of Medicine, The University of Sydney, New South Wales 2480, Australia. sbarzeev@usyd.edu.au
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Bar-Zeev
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
authors.forename: Cath
authors.initials: C
authors.lastname: Farrington
authors.forename: Sue
authors.initials: S
authors.lastname: Kildea
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006801:Humans; D007229:Infant Welfare / Q000706:statistics & numerical data; D007231:Infant, Newborn; D008297:Male; D008429:Maternal Welfare / Q000706:statistics & numerical data; D015876:Northern Territory / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011181:Postnatal Care / Q000458:organization & administration*; D011247:Pregnancy; D019984:Quality Indicators, Health Care; D012424:Rural Population / Q000706:statistics & numerical data*; D017751:Safety Management / Q000458:organization & administration*; D055815:Young Adult