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

Abstract

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 South West 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 (PMP S-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 PMP S-E scores with the intervention, the number of post-discharge visits to emergency departments (EDs) 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 estimated date of delivery (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.

Keywords: Neonatal care; discharge planning; family-centred; self-efficacy.