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Boomerang babies: emergency department utilization by early discharge neonates
A D Sacchetti1, M Gerardi, P Sawchuk
1Our Lady of Lourdes Medical Center, Camden, NJ, USA.
Insights
Early newborn discharge increases emergency department (ED) visits for infants within the first 10 days of life. However, admission rates for these neonatal visits did not rise, suggesting a need for better predischarge education.
Area of Science:
- Pediatrics
- Neonatal Care
- Emergency Medicine
Background:
- Average infant hospital stay post-delivery decreased by 1.8 days since 1987.
- This study addresses the impact of early newborn discharge on emergency department (ED) utilization.
Purpose of the Study:
- To evaluate if early newborn discharge increases ED visits in the first 10 days of life.
- To test the null hypothesis that early discharge does not affect neonatal ED utilization.
Main Methods:
- Retrospective review of 3.1 million ED visits between 1989-1995.
- Analyzed 2094 neonatal visits (NVs), comparing NV numbers to total ED visits.
- Calculated the ratio of neonatal visits per 10,000 ED visits and noted patient disposition and diagnosis.
Main Results:
- Neonatal visits per 10,000 ED visits rose from 4.3 in 1989 to 7.8 in 1995 (P < 0.001).
- Average infant hospital stay decreased from 2.79 to 1.85 days during the study period.
- The percentage of infants admitted from the ED remained stable at approximately 10.3%; most visits were for minor issues.
Conclusions:
- The null hypothesis is rejected: early newborn discharge leads to increased ED utilization.
- Increased ED visits did not correlate with higher admission rates, indicating no rise in infant illness severity.
- Improved predischarge education and accessible ambulatory care are recommended to manage increased ED visits.
Introduction:
Since 1987 the average length of stay for infants following hospital delivery has decreased 1.8 days. This study was undertaken to evaluate the null hypothesis that early discharge of newborns from nurseries does not result in increased emergency department (ED) utilization during the first 10 days of life. SITE: Thirty community EDs, one university ED.
Methods:
Retrospective review of ED visits of patients two to 10 days of age from 1989 to 1995. The absolute number of ED neonatal visits (NVs) was compared to the total number of ED visits for each year and the ratio of NV/10,000 ED visits determined. The disposition and diagnosis of each patient was noted, and the number and percent of infants admitted to the hospital calculated.
Results:
A total of 3.1 million ED visits were reviewed, and 2094 NVs identified. The ratio of NV/10,000 ED visits increased from 4.3 in 1989 to 7.8 in 1995 (P < 0.001), while the average length of stay for deliveries decreased from 2.79 days to 1.85 days. The mean percent of patients admitted from the ED was 10.3% and showed no statistically significant changes over the study period. The majority of visits were for minor medical or educational problems.
Conclusion:
The null hypothesis is rejected. Early discharge of neonates does result in increased ED utilization. No increase in admission rates for these infants was documented, indicating that patient severity did not increase with ED utilization. There is a need for improved predischarge education and greater access for episodic ambulatory complaints.
