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Preparing for Home: Increasing Parental Knowledge, Understanding and Confidence in Caring for their Preterm Infant Before and After Discharge Home

Presented at the Neonatal Society 2015 Summer Meeting.

Ingram J1, Blair P1, Powell J2, Pontin D3, Manns S2, Burden H5, Redshaw M4, Rose C6, Fleming P1

1 Centre for Child and Adolescent Health, University of Bristol, UK
2 University of the West of England, UK
3 University of South Wales, UK
4 University of Oxford, UK
5 University Hospitals Bristol, UK
6 North Bristol NHS Trust, UK

Background: Despite NICE guidance few neonatal units offer structured, family-oriented discharge planning, leaving parents of preterm infants ill-prepared for home, with increased out of hours service use. We implemented a parentoriented discharge planning approach (Train-to-Home) for preterm infants to investigate the effects on parental self-efficacy scores, infants’ length of stay (LOS) and use of healthcare resources in the 8 weeks after discharge.

Methods: We included parents of infants of 27-33 weeks gestation during two 11 month periods, before and after implementation of the Train-to-Home in 4 Local Neonatal Units. The parent-oriented package incorporated a train graphic and care pathways to facilitate parents’ understanding of their baby’s progress, with improved estimation of the baby’s likely discharge date. Outcome measures included Perceived Maternal Parenting Selfefficacy (PMPS-E) scores before and after implementing the Train-to-Home together with LOS and healthcare use after discharge.

Results: Parents welcomed the package and reported that the Train-to-Home improved their understanding of their baby’s progress, and their preparedness for discharge. There was no significant change in PMPS-E scores for mothers or fathers after implementation of the Train-to-Home, but the number of “out of hours” visits to Emergency Departments (ED) fell from 31 to 20 (p<0.05), with a significant reduction in associated healthcare costs (£3400 to £2200; p<0.05) after hospital discharge. There was no reduction in LOS, but in both phases of the study more than 90% of infants went home before their EDD, and more than 50% more than 3 weeks before the EDD. Many nurses felt that the estimated discharge dates were over optimistic, despite being based upon recent local data, and accurately predicting discharge dates for almost 75% of babies in the study.

Conclusion: Despite the lack of measurable effect on the parental self-efficacy scores, the parents reported that their understanding and confidence in caring for their infants were improved by the Train-to-Home, and the reduction in ED attendance and associated costs supports this assessment.

Corresponding author: peter.fleming@bris.ac.uk

Acknowledgements: Funded by a grant (11/1015/09) from the NIHR Health Services and Delivery Research Programme. Ethics approval from NRES Committee London – City & East in June 2012: 12/LO/0944.

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