FeBRILe3: Caregiver Satisfaction With Early Discharge of Febrile Infants Under 3 Months Old

Although evidence supports clinicians to "safely do less" for febrile infants assessed as low risk of serious bacterial infection (SBI), early discharge may increase caregiver concern and reduce satisfaction with care. We captured the self-reported satisfaction and concerns for families enrolled in the study of fever, blood cultures and readiness for discharge in infants less than 3 months old (FeBRILe3), a prospective safety assessment of early discharge of low-risk febrile infants, to aid evaluation of this practice.

An updated local policy was implemented at 2 Western Australian hospitals allowing febrile infants (<3 months old) fulfilling low-risk criteria for SBI to be discharged from 24 hours after admission. An electronic survey was administered 7 to 10 days postdischarge to caregivers of 500 febrile infants admitted August 2019 to December 2021. The survey included free-text and 5-point Likert-scale questions on hospitalization/discharge experiences. Responses were evaluated by length of stay (LOS; <36 hours, 36 hours to <48 hours, or >=48 hours) and risk-stratification (low-risk or nonlow-risk) groups.

Caregiver responses were obtained for 298 infants (60%). Fifty-one infants (17%) were discharged before 36 hours, including 7 of 38 infants fulfilling low-risk criteria. Sixty-eight infants (23%) were discharged between 36 hours and less than 48 hours. Ninety-one percent of caregivers "agreed" or "strongly agreed" their infant was ready for home at time of discharge. Responses were comparable for low-risk infants discharged before 36 hours (86%) vs after 36 hours (93%). Most caregivers (84%) "agreed" or "strongly agreed" that discharge timing enabled a quick return to family routine. Caregivers of low-risk infants discharged before 36 hours missed fewer workdays (median 1.5 vs 2.5 days for LOS >=36 hours). Free-text feedback identified the importance to caregivers of clear communication and shared decision-making.

Early discharge was related to high caregiver satisfaction, regardless of risk stratification, supporting continued implementation of this policy. Strengthening communication and streamlining discharge processes may further enhance satisfaction and support early discharge.