Does family-centred neonatal discharge planning reduce healthcare usage? A before and after study in South West England

Jenny C Ingram, Jane E. Powell, Peter S Blair, David Pontin, Margaret E Redshaw, Sarah Manns, Lucy Beasant, H Burden, Debbie G F Johnson, Claire Rose, Peter J Fleming

Research output: Contribution to journalArticle (Academic Journal)peer-review

35 Citations (Scopus)
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Objective. To implement parent-oriented discharge planning (Train-to-Home) for preterm infants in neonatal care.

Design. Before and after study, investigating the effects of the intervention during two 11 month periods before and after implementation.

Setting. Four Local Neonatal Units (LNUs) in Southwest England.

Participants. Infants without major anomalies born at 27-33 weeks gestation admitted to participating units, and their parents.

Train-to-Home Intervention. 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.

Main outcome measures. Perceived Maternal Parenting Self-efficacy (PMPS-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 PMPS-E scores with the intervention, the number of post-discharge 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 discharge. In both study phases over 50% of infants went home more than 3 weeks before their 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.
Original languageEnglish
Article numbere010752
Number of pages10
JournalBMJ Open
Issue number3
Early online date11 Feb 2016
Publication statusPublished - Mar 2016


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