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: firstname.lastname@example.org
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.