In 1997, a review of 28 studies of early discharge (<48 h following vaginal birth and <96 h following CS birth) concluded that data neither supported nor refuted early postpartum discharge for the general population [6]. Ongoing assessment of the infant and mother–infant dyad throughout the hospital stay helps ensure safe discharge. 6. Models for postdischarge newborn care include office or hospital visits with a physician or nurse, and home visits by nurses or midwives. OBJECTIVES: In 2015, the American Academy of Pediatrics (AAP) published an updated consensus statement containing 17 discharge recommendations for healthy term newborn infants. 26 May 2016. Pediatrics 1998;102(6):1437–44. 3 0 obj Yonemoto N, Dowswell T, Nagai S, Mori R. Schedules for home visits in the early postpartum period. Eur J Pediatr 2012;171(1):167–71. Hearing and newborn screens have been scheduled (if they were not conducted in-hospital); appropriate follow-up for jaundice; vitamin D supplementation if breast-fed; other follow-up, as required. CMAJ 2003;169(3):207–8. Discharge criteria, inclusive of a post anesthetic recovery score system Jefferies AL; Canadian Paediatric Society, Fetus and Newborn Committee. Ottawa: Minister of Public Works and Government Services Canada; 2000. Four systematic reviews have summarized studies of early discharge for term newborns. Because the risk of hemorrhagic disease of the newborn is higher when vitamin K is not given intra-muscularly, it is crucial that follow-up doses are given. Choosing the infant’s primary HCP during pregnancy not only facilitates the discharge process but provides parents with an opportunity to discuss their newborn’s care, ask questions and familiarize themselves with the provider’s practice. Arch Dis Child 2006;91(3):238–40. Care providers should be sensitive to the interaction between infant, mother and family; it is important to identify concerns about the mother’s ability to care for her infant. These include but are not limited to: Legible and complete antenatal records must be readily available for review by the infant’s HCP. endobj Chen YJ, Chen WC, Chen CM. 11. avoidable adverse events expressed as falls (1 study, very low quality), length of stay (5 studies, moderate quality), quality of life SF-12 mental ratings (1 study, very low quality) patient and/or carer. ϜT�쳤���/gSL�lH3gt�Y�kdy�T���e%Ɉʥ7���1:�>���Mx���W��a9y�!x}�1�H&�?�|���}{������ƫ�ez�*d���7c����|!���3�f#����~�I@�s��`�� r*� Screening for issues of concern, behavior, and/or medical problems that may impact a safe discharge can be identified at The definition of early discharge ranged from 6 h to 72 h after childbirth but was shorter than the standard LOS for the hospitals included in each trial. The objective should be to achieve a safe and early discharge. Lomax A, editor. Paediatr Child Health 2014;19(4):201–12. ׅe�����/�dO H7C��'P����. Findings that may be missed include cleft palate and imperforate anus [27][28]. Infants born at 37 weeks’ GA tend to have a longer hospital LOS compared with infants ≥38 weeks’ GA [17]. Gastrointestinal obstruction and hyperbilirubinemia requiring treatment are not always clinically apparent within 24 h of birth [14][15]. Rourke L, Leduc D. Rourke Baby Record: (Accessed May 7, 2018). Parents have demonstrated that they can position the seat and secure the infant appropriately. Relevant publications from Health Canada, the Public Health Agency of Canada and Statistics Canada were obtained. Chichester, UK: Wiley-Blackwell, 2015. Use of a discharge readiness checklist (Table 1) can improve consistency and ensure thoroughness. Johnson D, Jin Y, Truman C. Early discharge of Alberta mothers post-delivery and the relationship to potentially preventable newborn readmissions. endobj Lavagno C, Camozzi P, Renzi S, et al. Wong KK, Fournier A, Fruitman DS et al. The Agency for Healthcare Research and Quality offers information and tools for clinicians and patients to make the hospital discharge process safer and to prevent avoidable readmissions. Safe Discharge from Hospital Always make sure at least one family member or friend is present when you review your specific discharge instructions with your doctor and nurse. Transfer from the ward should happen within one hour of that decision being made to a designated discharge area. %���� All recommendations are developed from the best evidence available, based on consensus, and fully consistent with evidence-based best practice [67]. 3. Each infant must have an appropriate discharge plan, including identification of the infant’s primary health care provider and assessment by a health care provider 24 h to 72 h after discharge. Pediatr Neonatol 2012;53(1):41–4. Going home: Facilitating discharge of the preterm infant. Can J Cardiol 2017;33(2):199–208. New grades for recommendations from the Canadian Task Force on Preventive Health Care. In Canada, as elsewhere, length of postpartum stay has decreased. Several studies … Pediatrics 2016;138(6):e20163107. The specific hospital length-of-stay (LOS) for healthy term (≥37 weeks’ gestational age (GA)) newborns depends on the health of the mother, infant health and stability, the mother’s ability to care for her infant, support at home, and access to follow-up care. Habel A, Elhadi N, Sommerlad B, Powell J. Medicare states that discharge planning is “a process used to decide what a patient needs for a smooth move from one level of care to another. Neonatal examination and screening trial (NEST): A randomised, controlled, switchback trial of alternative policies for low risk infants. This page features links to AHRQ's resources for preventing avoidable readmissions or … Hospital discharge planning is a process that determines the kind of care you need after you leave the hospital. A Covid-19 patient meeting the following criteria can be considered for discharge: afebrile without use of fever-reducing agents for at least 48 hours improving hypoxia and respiratory symptoms (particularly shortness of breath, since up to 29% of patients may have persistent cough for up to 3 weeks) Vitamin K and ophthalmia neonatorum prophylaxis have been administered in accordance with provincial/territorial guidelines. Screening for hyperbilirubinemia within the first 72 h of age is recommended by both the CPS ( and the American Academy of Pediatrics, using a predictive nomogram [45][46]. All discharge criteria identified in Section 2 of the CLD form must be met prior to discharge from hospital. Turowski C, Dingemann J, Gillick J. Dietz PM, Rizzo JH, England LJ, et al. Paul IM, Beiler JS, Schaefer EW et al. Bernstein HH, Spino C, Finch S et al. Successful cardiorespiratory adaptation to extrauterine life, with normal, stable heart and respiratory rates. Breastfeeding-associated hypernatremia: A systematic review of the literature. A structured checklist can help to document findings and ensure that the examination is complete (see Appendix). Martens PJ, Derksen S, Gupta S. Predictors of hospital readmission of Manitoba newborns within six weeks postbirth discharge: A population-based study. A mechanism for preventive medicine in the newborn. Health Canada. Also, some infants may be taken into care or be discharged to foster families. Consent. Pediatr Surg Int 2010;26(11):1083–6. Many mother–infant dyads are ready to go home 24 h after birth. <> essential elements of a safe, comprehensive, and quality discharge from the ED. Desmond MM, Rudolph AJ, Phitaksphraiwan P. The transitional care nursery. Discharge criteria for confirmed COVID-19 cases – When is it safe to discharge COVID-19 cases from the hospital or end home isolation? Verify here. NICE guidance addresses the need for safe and appropriate discharge from hospital Two reports have raised alarming concerns about the way patients are discharged from hospital. Pediatrics 2015;135(5):948–53. Ciaramella J, Longworth N, Larraz L, Murphy S. Improving efficiency, consistency and satisfaction on a mother-baby unit with the discharge nurse position. POLICY III. Check if you have sufficient money with you for the first few days out of hospital. Make sure there are fresh groceries at home in preparation for discharge. During the hospital stay, the mother’s ability to care for her infant should be assessed, along with her level of confidence. endobj BMJ 1991;302(6781):878–9. The postnatal period is one of significant transition for mother, infant and family. Rev Esc Enferm USP 2011;45(3):758–63. Table 102–4516, Live births and fetal deaths (stillbirths), by place of birth (hospital and non-hospital), Canada, provinces and territories: (Accessed May 7, 2018). Examples of interventions that help to ensure a safe transition from the hospital include discharge planning, medication reconciliation, patient education, follow-up appointment scheduling, communication with community partners, and summaries of care given in the hospital. Hospital discharge planning is a process that involves determining the appropriate post-hospital discharge destination for a patient; identifying what the patient requires for a smooth and safe The most appropriate criteria to indicate readiness for discharge after colorectal surgery are unknown. The well-planned, comprehensive discharge of a medically stable infant helps to ensure a positive transition to home and safe, effective care after discharge. METHODS: A stratified random sample of charts from newborns who were … Criteria Led Discharge ( CLD) is a process to ensure patients can return home from hospital as safely and quickly as possible. Document first published: 19 March 2020 Page updated: 3 September 2020 Topic: Coronavirus, COVID-19 Publication type: Guidance. Criteria for the safe discharge of patients from the recovery room AUTHOR Helen Reed, RGN, BA, is staff nurse, Freeman Hospital, Newcastle upon Tyne. This statement was also reviewed by members of the Society of Obstetricians and Gynaecologists of Canada Family Physicians Advisory (FPAC) and Clinical Practice Obstetrics and Maternal Fetal Medicine (MFM) Committees. Unreadiness for postpartum discharge following healthy term pregnancy: Impact on health care use and outcomes. 8. Jackson GL, Kennedy KA, Sendelbach DM et al. The specific length of stay for newborn infants depends on the health of their mother, infant health and stability, the mother’s ability to care for her infant, support at home, and access to follow-up care. Scientific World Journal 2003;3:1363–9. Canadian Hospitals Maternity Policies and Practices Survey (2012). Several Canadian studies have shown that being a first-time parent, younger GA and low household income are factors associated with increased readmission rate [36]-[38]. Current Opin Pediatrics 2004;14(4):361–5. Hospital care for mothers and infants should be family-centred, with healthy mothers and infants remaining together and going home at the same time. Acad Pediatr 2013;13(1):27–39. Physicians tend to focus on infant clinical and physical factors, although maternal age, social risk factors, fatigue, and stress are important considerations [40]. Pediatrics 2015;135(1):e16–23. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation (Clinical practice guideline). J Perinatol 2010;30(Suppl):S6–15. Clin Pediatr (Phila) 2000;39(10):581–90. II. Physical examination (including head circumference and length) by a health care provider is complete and documented, with no additional in-hospital or ongoing observations or treatments needed. SNF Discharge Planning; A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility (42 C.F.R. Hagan JF, Shaw JS, Duncan PM, editors. Because some newborn problems may not be apparent early on, it is prudent to re-examine infants assessed during the first 6 h of age. Shakib J, Buchi K, Smith E, Korgenski K, Young PC. Available by request at (Accessed May 7, 2018). All provinces and territories in Canada have public health-sponsored early child home visiting programs in place to improve health equity and outcomes for children and their families [65]. Up to 30% of nonsyndromic critical congenital heart disease may not be diagnosed definitively during the first 3 days of life, although the presence of cardiac disease may have been recognized [16]. Reference lists of published guidelines, articles, and other publications were reviewed. Healthy term infants should be considered ready for discharge home when all criteria in Table 1 have been met. Similarly, ‘mother’ refers to any parent giving birth or, in the case of surrogacy, to the adult(s) adopting an infant. Check if you have adequate heating/cooling immediately you get home. The authors concluded that same-day discharge is safe for patients with suspected or biopsy-proven MH after uncomplicated ambulatory surgery. Many studies use hospital readmission as an outcome measure, which presupposes that readmission, including readmission for jaundice, indicates morbidity. Aziz K, Dancey P; Canadian Paediatric Society, Fetus and Newborn Committee. The purposes of the newborn assessment include ensuring successful transition from intrauterine life, identifying abnormal clinical findings, following-up problems detected antenatally, obtaining measurements of head circumference, length and weight, and confirming GA. Under CLD the decision for discharge is made and documented by the senior medical clinician (e.g. Variations, taking into account individual circumstances, may be appropriate. The guidelines have an e… ” Only a doctor can authorize a patient ʼ s release from the hospital, but the actual process of discharge planning can be completed by a social worker, nurse, case manager, or other person. 4 0 obj Vertical transmission of the hepatitis C virus: Current knowledge and issues. 1007: (Accessed May 7, 2018). 7. For permission to reprint or reproduce multiple copies, please see our copyright policy. Pulse oximetry screening for critical congenital heart disease (CCHD) is now recommended for term infants before discharge. However, there does not appear to be significant health benefit to re-examining well, low-risk infants before discharge when the initial routine examination was performed in the first 24 h to 72 h postbirth [24][25]. Montreal: Technologies CETS 97-6 RE. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. The term baby. Several studies have shown that approximately 50% to 95% of problems necessitating transfer to a higher level of care or readmission after discharge were detected during the first 24 h of life [11]–[13]. Bravo P, Uribe C, Contreras A. Canada’s Family-Centred Maternity and Newborn Care: National Guidelines [1] outline the goals of care during this time: For this statement, the term ‘family’ is intended to reflect the diversity of families in Canada, including those with single parents and same-sex partners and adoptive families. Nurs Womens Health 2014;18(4):333–9. In Canada, approximately 98% of infants are born in a hospital [2]. However, concerns have been expressed that time for parental education has decreased, postnatal problems may not be identified in a timely manner, readmissions for problems such as jaundice and dehydration have increased, and duration of breastfeeding may be shorter. Bacille Calmette-Guerin (BCG) vaccine can be considered for infants in high-risk communities or born to mothers with infectious tubercular disease [49]. Catalogue No. Adequacy of breastfeeding can be assessed by direct observation of the feeding position, latch and swallow. Impact of newborn follow-up visit timing on subsequent ED visits and hospital readmissions: An instrumental variable analysis. Antenatal and perinatal infant risk factors including (but not limited to) sepsis, neonatal abstinence syndrome, jaundice and hypoglycemia, should be evaluated and monitored. {}������`I�&�6��er� <>/Metadata 340 0 R/ViewerPreferences 341 0 R>> Any parental questions should be answered. In Canada, specific screening programs vary among the provinces and territories [44]. Newborn screening programs for metabolic and other serious diseases, and for hearing impairment [43] facilitate timely recognition, follow-up and intervention, and should be available for all infants. Many mother–infant dyads will be ready to go home 24 h after birth. Bhutani VK, Vilms RJ, Hamerman-Johnson L. Universal bilirubin screening for severe neonatal hyperbilirubinemia. stream The purpose of this statement is to provide guidance for HCPs and ensure safe discharge of healthy term infants who are ≥37 weeks’ gestational age (GA) at birth. Pediatrics 2004;114(3):708–13. Healthy mothers and infants should remain together and go home at the same time. During the hospital stay, health care providers (HCPs) should evaluate the infant’s physical health, identify early problems, assist with establishment of feeding, observe parent–infant interaction, and identify psychosocial stressors. World J Pediatr 2014;10(3):211–8. Appropriate education should be provided to families about warning signs after discharge and when to seek medical attention. The scope of the first postdischarge HCP review should always include assessment of weight loss, jaundice, hydration, general health, feeding, and any congenital malformation not seen at the initial examination in hospital. Surg Clin North Am 2012;92(3):685–711, ix–x. Joint Statement on Safe Sleep: Preventing Sudden Infant Deaths in Canada, 2011. (Accessed May 7, 2018). Early weight loss nomograms for exclusively breastfed newborns. Pediatrics 2004;114(1):297–316. Timing of initial well-child visit and readmissions of newborns. When a decision has been made to discharge a healthy infant before 24 h of age, the HCP should ensure that: the infant has transitioned appropriately; there are no risk factors that require close monitoring, necessary screening occurs, with follow-up, and support for the family is readily available. Universal newborn hearing screening. (Accessed May 7, 2018). 1. Paediatr Child Health 2010;15(10):655–60. Can J Public Health 2002;93(4):276–80. Decide how will you get home from hospital. BMJ 1999;318(7184):627–31. Measurement of either total serum or transcutaneous bilirubin appears to have similar predictive value for significant hyperbilirubinemia [47]. An abnormality is detected in approximately 8% to 10% of newborns [24][25]. A randomized comparison of home and clinic follow-up visits after early postpartum hospital discharge. Most newborn care guidelines recommend a postdischarge assessment by an HCP within the first week of life. If not required earlier because of clinical jaundice, a bilirubin measurement should be obtained at the same time as the metabolic screening test; alternatively, a bilirubin measurement should be done at discharge or at 72 h of life, whichever comes first. Gagnon AJ, Dougherty G, Jimenez V, Leduc N. Randomized trial of postpartum care after hospital discharge. Canadian Immunization Guide: (Accessed May 7, 2018). Consider discharge for patients’ who meet the following clinical criteria: • Resolution of fever >48 hours without antipyretics • Improvement in illness signs and symptoms (cough, shortness of breath, and oxygen requirement) Privacy Policy, Search position statements and practice points, Most current statements and practice points, Education Program for Immunization Competencies, International Meeting on Indigenous Child Health, NRP Research Grant and Emerging Investigator Award, How much? All parents should receive counselling on infant care, signs of illness and how to respond, and infant safety, including safe sleep practices. Lieu TA, Wikler C, Capra AM, Martin KE, Escobar GJ, Braveman PA. Clinical outcomes and maternal perceptions of an updated model of perinatal care. 1. The hospital discharge service requirements provide actions that must be taken immediately to enhance discharge arrangements and the provision of community support. Brigitte Lemyre, Ann L. Jefferies, Pat O’Flaherty; Canadian Paediatric Society, Fetus and Newborn Committee, Paediatr Child Health 2018, 23(8):515–522. Ideally, the examination should be performed in the mother’s room, with parents present, to minimize separation of mother and baby, facilitate parental questions, and provide confidentiality. without being infectious) Am J Dis Child 1984;138(11):1041–6. A shorter postpartum LOS highlights that low-risk birth is an event defined by ‘wellness’ rather than illness. Early postnatal hospital discharge: The consequences of reducing length of stay for women and newborns. I. Senior Consultant, Medical Fellow, Visiting Medical Officer). Pan-Canadian inventory of public health early child home visiting: Key facts and glossary. Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants. O’Donnell HC, Colman G, Trachtman RA, Velazco N, Racine AD. The American Academy of Pediatrics specifies that this assessment should take place 48 h to 72 h after discharge when a newborn has been discharged <48 h postdelivery [52][53]. Hepatitis B vaccine can be considered for infants born to mothers with hepatitis C infection [50]. Table 1 should be customized for specific hospital and health region policies, because requirements and programs vary considerably by jurisdiction. Hearing screening is completed or scheduled; when required, follow-up has been organized. Further anticipatory guidance regarding infant safety, feeding, provision of vitamin D [59], and routine infant care should be provided. Flaherman VJ, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM, Paul IM. Vitamin D supplementation: Recommendations for Canadian mothers and infants. A comprehensive and systematic newborn examination is an opportunity to identify normal variants and medically unimportant findings, and to provide reassurance about these [26].