PC1253: Improving Timeliness of Newborn Discharge in a Suburban Health System Decreased Readmissions

Purpose/Objectives: Timely newborn discharge is a key driver of maternal labor and delivery (L & D) throughput. A recent study showed implementation of a newborn discharge checklist improved timely newborn discharge from a pediatric hospitalist service in a suburban hospital, but the impact on newborn readmission was not evaluated. We sought to improve newborn and, consequently, maternal L & D throughput, by increasing the percentage of newborns with a discharge order placed by 11 am to 80% in 12 months without an associated increase in newborn hospital readmissions.

Design/Methods: The project was done in a suburban four-hospital health system with an average of 7400 total annual deliveries. Newborn care is provided by community pediatrician group practices. The Plan-Do-Study-Act model for improvement was used. Intervention involved discharge process standardization culminating in placement of a discharge order by 11 am on the second post-partum day for newborns delivered vaginally (V), and the third post-partum day for Caesarian section (CS). Length of stay (LOS) and readmission data were collected for all uncomplicated deliveries entered in the electronic health record from May 2018 to October 2021. For the first cycle, the three busiest pediatrician groups (who historically cared for 75% of newborns) participated. For the second cycle, all newborn provider groups were asked to participate. For the 3rd cycle, results were shared with all provider groups in departmental meeting and in follow-up email. Two sample t-tests were performed to compare the LOS in hours and the seven-day newborn readmission rate pre- and post-intervention.

Results: Our cohort included 23,579 newborns, 66% delivered vaginally and 34% delivered by CS. Of these, 7,613 (vaginal) and 3,952 (CS) were in the pre-intervention whereas 7,918 (vaginal) and 4,096 (CS) were in the post-intervention groups. The timely discharge baseline for V was 78%; CS was 71%. For V, the timely discharge goal was achieved consistently with a mean of 86.2% ; for CS, the timely discharge goal was achieved, except for two months, with a mean of 83.9% (Figure 1). There was no significant difference in pre-and post-intervention LOS for newborns delivered vaginally (42.8 vs 38.1 hours, p = 1.79) or by C- section (68.1 vs 58.6, p = 1.66). There was, however, a significant difference in the readmission rate pre-intervention (mean = 1.37%) and post-intervention (mean = 1.05%), p = 0.04 (Figure 2).

Conclusion/Discussion: The percentage of timely newborn discharges improved in our four-hospital suburban health system, initially by engaging the busiest pediatric practices, and then involving all other practices and sharing results. The newborn readmission rate decreased significantly (p < 0.05) post-intervention, most likely from enhanced newborn follow-up care, a consequence of timely discharge.