title: Does family-centred neonatal discharge planning reduce healthcare usage? A before and after study in South West England.
abstract: OBJECTIVE
  To implement parent-oriented discharge planning (Train-to-Home) for preterm infants in neonatal care.
  
  
  METHODS
  Before and after study, investigating the effects of the intervention during two 11-month periods before and after implementation.
  
  
  METHODS
  Four local neonatal units (LNUs) in South West England.
  
  
  METHODS
  Infants without major anomalies born at 27-33 weeks' gestation admitted to participating units, and their parents.
  A family-centred discharge package to increase parents' involvement and understanding of their baby's needs, comprising a train graphic and supporting care pathways to facilitate parents' understanding of their baby's progress and physiological maturation, combined with improved estimation of the likely discharge date.
  
  
  METHODS
  Perceived Maternal Parenting Self-Efficacy (PMP S-E) scores, infant length of stay (LOS) and healthcare utilisation for 8 weeks following discharge.
  
  
  RESULTS
  Parents reported that the Train-to-Home improved understanding of their baby's progress and their preparedness for discharge. Despite a lack of change in PMP S-E scores with the intervention, the number of post-discharge visits to emergency departments (EDs) fell from 31 to 20 (p<0.05), with a significant reduction in associated healthcare costs (£3400 to £2200; p<0.05) after discharge. In both study phases, over 50% of infants went home more than 3 weeks before their estimated date of delivery (EDD), though no reduction in LOS occurred.
  
  
  CONCLUSIONS
  Despite the lack of measurable effect on the parental self-efficacy scores, the reduction in ED attendances and associated costs supports the potential value of this approach.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Jenny C
authors.initials: JC
authors.lastname: Ingram
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Powell
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Blair
authors.affiliation: Faculty of Life Science and Education, University of South Wales, Pontypridd, UK.
authors.forename: David
authors.initials: D
authors.lastname: Pontin
authors.affiliation: Department of Population Health, NPEU, University of Oxford, Oxford, UK.
authors.forename: Maggie
authors.initials: M
authors.lastname: Redshaw
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Manns
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Beasant
authors.affiliation: South West Neonatal Network, Bristol, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Burden
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Debbie
authors.initials: D
authors.lastname: Johnson
authors.affiliation: Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Rose
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fleming
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D010290:Parents / Q000193:education*; D010351:Patient Discharge
keywords: Neonatal care; discharge planning; family-centred; self-efficacy