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Early neonatal discharge guidelines: Have we dropped the ball?
L K Purcell1, T J Kennedy, K A Jangaard
1Departments of Paediatrics and.
Insights
Many family physicians do not consistently follow Canadian guidelines for early neonatal discharge follow-up and prenatal education. Reinforcement strategies are needed to improve physician compliance with these important practice guidelines.
Area of Science:
- Neonatal care
- Family medicine
- Public health guidelines
Background:
- Early neonatal discharge programs (EDP) are increasingly common.
- The Canadian Paediatric Society/Society of Obstetricians and Gynecologists of Canada (CPS/SOGC) issued guidelines in 1996 for neonatal follow-up and parental education.
- Compliance with these guidelines by family physicians is not well understood.
Purpose of the Study:
- To investigate family physician practices regarding neonatal follow-up timing and prenatal education.
- To evaluate adherence to the 1996 CPS/SOGC guidelines for early neonatal discharge.
Main Methods:
- A mail survey was conducted among family physicians providing prenatal and/or newborn care.
- The study setting was a community served by a tertiary care hospital with an established early discharge program.
- Key outcome measures included the timing of neonatal follow-up and parental teaching.
Main Results:
- 32% of physicians scheduled postnatal visits two or more weeks after early discharge.
- No significant difference in follow-up scheduling was observed between babies in EDPs and those not in EDPs.
- Fewer than 20% of physicians provided antenatal education for early discharge.
Conclusions:
- Current family physician practices do not consistently align with 1996 CPS/SOGC guidelines for neonatal follow-up and parental education.
- The guidelines were disseminated without reinforcement, potentially impacting compliance.
- Effective implementation strategies are necessary to ensure physician adherence to established practice guidelines.
Objectives:
To determine patterns of follow-up and prenatal education by family physicians and to assess whether practice patterns comply with the 1996 Canadian Paediatric Society/Society of Obstetricians and Gynecologists of Canada (CPS/SOGC) guidelines for early neonatal discharge.
Design:
Mail survey.
Setting:
A community of 300,000 people who were served exclusively for obstetrical care by a tertiary care hospital that performs 5000 deliveries per year and provides an early discharge program (EDP).
Participants:
Family physicians who provide prenatal and/or newborn care.
Main Outcome Measures:
The timing of neonatal follow-up and parental teaching by family physicians.
Results:
Thirty-two per cent of the respondents scheduled their first postnatal visits two or more weeks after early discharge. There was no significant difference (P=0.7) in scheduling of follow-up for babies who were part of an EDP compared with those who were not. Fewer than 20% of physician respondents provided antenatal education in preparation for early discharge.
Conclusions:
The 1996 CPS/SOGC guidelines for physician follow-up after early neonatal discharge and for anticipatory parental education are not being followed consistently; however, these guidelines were disseminated without reinforcement. Until further study supports a change in practice guidelines, appropriate implementation strategies must be employed to ensure compliance.
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