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Description and evaluation of a program for the early discharge of infants from a neonatal intensive care unit
U R Kotagal1, P H Perlstein, V Gamblian
1Center for Clinical Effectiveness, University of Cincinnati and Children's Hospital Medical Center, OH, USA.
Insights
Early discharge programs for high-risk neonates significantly reduce hospital costs and length of stay. This cost-containment strategy saves substantial hospital charges without increasing infant morbidity, demonstrating program effectiveness.
Area of Science:
- Neonatal Intensive Care Unit (NICU) care
- Healthcare cost containment strategies
- High-risk infant management
Background:
- Neonatal intensive care units (NICUs) face challenges in managing high-risk infants and controlling costs.
- Early discharge programs aim to reduce the length of hospital stay for neonates.
- Assessing the impact of cost-containment programs on neonatal care is crucial.
Purpose of the Study:
- To evaluate the effectiveness of a cost-containment program designed to shorten hospital stays for high-risk neonates.
- To compare outcomes, including length of stay and costs, between infants in an early-discharge program and control infants.
- To assess the impact on infant morbidity, such as emergency department visits and readmissions.
Main Methods:
- A comparative study design was used, comparing 257 infants in an early-discharge program with 477 control infants from a prior period.
- Data collected included discharge weights, lengths of stay, demographic information, costs, emergency department use, and hospital readmissions.
- Analysis focused on changes in mean discharge weight and length of stay, as well as overall cost savings.
Main Results:
- The study group experienced a significant decrease in mean discharge weight and length of stay compared to controls.
- The program resulted in an estimated saving of 2073 hospital days and approximately $2,700,000 in charges over 7 months.
- Program costs were $120,413, yielding a cost reduction 30 times higher than program expenses, with minimal increase in emergency visits or readmissions.
Conclusions:
- Significantly earlier discharge of high-risk neonates can effectively decrease hospital charges without leading to excessive morbidity.
- The success of the early-discharge program is presumed to be linked to comprehensive family support and early discharge planning.
- This strategy offers a cost-effective approach to managing high-risk neonates, improving resource utilization in NICUs.
Abstract:
The effect of a cost-containment program focused on decreasing the lengths of hospital stay of high-risk neonates was assessed by comparison of discharge weights and lengths of stay for 257 study infants, discharged from a neonatal intensive care unit (NICU) after an early-discharge program began, with those of 477 control infants discharged during a prior 1-year period. Demographic data and costs, as well as data on emergency department use and hospital readmissions, were included in the comparisons. There was a significant decrease in mean discharge weight and length of stay for infants in the study group. During a 7-month period, an estimated 2073 days of hospital care and approximately $2,700,000 in hospital charges were saved, or $10,609 per infant discharged. The cost of instituting and maintaining the program was $120,413, or $468 per infant. Seven visits were made to the emergency department by the study infants during the first 14 days after discharge. One infant was readmitted for a 4-day hospital stay for suspected sepsis. Significantly earlier discharge of high-risk neonates produced a decrease in hospital charges without causing excessive morbidity. The success of the program was coincident and presumed related to the institution of multiple elements focused toward family support through early-discharge planning. The reduction in hospital charges was 30 times higher than program expenses.