Brumfield C G, Nelson K G, Stotser D, Yarbaugh D, Patterson P, Sprayberry N K
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA.
Obstet Gynecol. 1996 Oct;88(4 Pt 1):544-8. doi: 10.1016/0029-7844(96)00267-0.
To determine safety and cost-effectiveness of 24-hour discharge in selected mothers and newborns.
Women delivering at University Hospital (the University of Alabama at Birmingham) were screened to determine their eligibility for 24-hour discharge. Mothers were eligible if they had no medical problems and no history of substance abuse, had an uncomplicated vaginal delivery and postpartum course, were 12 or more hours after postpartum bilateral tubal ligation, and had reached 24 hours after delivery by 6:00 PM on the day of discharge. Newborns were eligible if they were term (37 weeks or greater), weighted 2500 g or greater, and had a normal examination at 24 hours of age. At 48 hours after delivery, each mother and infant pair was examined by a home health nurse. Telephone consultations with a staff physician were noted and outcomes were entered into a data base linked to hospital financial data.
Of 5621 deliveries from October 1, 1993 to September 30, 1995, 972 mothers (17%) and 856 (15%) newborns were discharged at 24 hours. One mother was lost to follow-up after discharge. Nine-hundred fifty-six of 971 mothers (98.5%) had a normal examination at the home visit. Fifteen of 971 mothers (1.5%) had problems that required obstetrician telephone consultation. Seven mothers (0.7%) required a physician visit; two of these women were readmitted for treatment of an infection. Seven-hundred ninety-five of 856 (93%) newborns had a normal examination. Sixty-one newborns (7%) had problems that required pediatrician telephone consultation, primarily for jaundice, infant care questions, and a cardiac murmur. Twelve infants (1.4%) required a pediatric clinic visit. No infant was readmitted to the hospital. Net cost savings to our hospital for 24-hour discharge in these selected patients was $ 506,139 during a 2-year period.
In a selected, low-risk, low-income population, mother-infant discharge 24 hours after delivery with a home follow-up visit is safe and cost-effective.
确定特定母亲和新生儿24小时出院的安全性和成本效益。
对在大学医院（阿拉巴马大学伯明翰分校）分娩的妇女进行筛查，以确定她们是否符合24小时出院的条件。母亲符合条件的标准为：无医疗问题且无药物滥用史，顺产且产后过程顺利，产后双侧输卵管结扎12小时或更长时间，出院当天下午6点时已分娩24小时。新生儿符合条件的标准为：足月（37周或以上），体重2500克或以上，出生24小时时检查正常。分娩后48小时，由家庭健康护士对每对母婴进行检查。记录与主治医师的电话咨询情况，并将结果录入与医院财务数据相关的数据库。
在1993年10月1日至1995年9月30日的5621例分娩中，972名母亲（17%）和856名（15%）新生儿在24小时时出院。1名母亲出院后失访。971名母亲中有956名（98.5%）在家庭访视时检查正常。971名母亲中有15名（1.5%）出现问题，需要产科医生电话咨询。7名母亲（0.7%）需要医生上门就诊；其中2名妇女因感染再次入院治疗。856名新生儿中有795名（93%）检查正常。61名新生儿（7%）出现问题，需要儿科医生电话咨询，主要原因是黄疸、婴儿护理问题和心脏杂音。12名婴儿（1.4%）需要到儿科门诊就诊。无婴儿再次入院。在两年期间，这些特定患者24小时出院为我院节省的净成本为506,139美元。
在选定的低风险、低收入人群中，母婴在分娩后24小时出院并进行家庭随访是安全且具有成本效益的。
