Harry D. Atherton

Description and evaluation of a program for the early discharge of infants from a neonatal intensive care unit.

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

Neonatal hypocalcemia in infants with birth asphyxia

2,700,000 in hospital charges were saved, or

Intensive home visiting is associated with decreased risk of infant death

10,609 per infant discharged. The cost of instituting and maintaining the program was

Characteristics of nonurgent emergency department use in the first 3 months of life

120,413, or

Use of hospital-based services in the first three months of life: Impact of an early discharge program

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.

Implementing an Evidence-Based Acute Gastroenteritis Guideline at a Children’s Hospital

Summary Forty-two infants with birth asphyxia (1 minute Apgar Score of 6 or less) and 42 control infants matched for gestational age and sex were studied serially from birth to 72 hours of age. In infants with birth asphyxia, serum Ca at 12 and 24 hours was lower than that of control infants and serum Mg was lower from 12 to 48 hours. No differences were detected in urinary Ca and Mg excretion. A calcemic response to parathyroid extract was elicited. Lower serum Ca values were found in asphyxiated infants who received sodium bicarbonate therapy, even when gestational age was considered. Serum P was higher in infants with birth asphyxia, whereas urinary P excretion was not different from infants without asphyxia. It is speculated that bicarbonate therapy, increased phosphate loads, and functional hypoparathyroidism may play contributory roles in the pathogenesis of the hypocalcemia of birth asphyxia.

Prenatal care and infant emergency department use.

OBJECTIVE. The goal was to test the hypothesis that participation in a community-based home-visiting program is associated with a decreased risk of infant death. METHODS. A retrospective, case-control design was used to compare the risk of infant death among participants in Cincinnatis Every Child Succeeds program and control subjects matched for gestational age at birth, previous pregnancy loss, marital status, and maternal age. The likelihood of infant death, adjusted for level of prenatal care, maternal smoking, maternal education, race, and age, was determined with multivariate logistic regression. The interaction between race and program participation and the effect of home visiting on the risk of preterm birth were explored. RESULTS. Infants whose families did not receive home visiting (n = 4995) were 2.5 times more likely to die in infancy compared with infants whose families received home visiting (n = 1665). Black infants were at least as likely to benefit from home visiting as were nonblack infants. No effect of program participation on the risk of preterm birth was observed. CONCLUSION. The current study is consistent with the hypothesis that intensive home visiting reduces the risk of infant death.

Differential Markers for Regionalization

Objectives To determine the characteristics of nonurgent emergency department (ED) visits in the first 3 months of life. Methods The study cohort consisted of full-term newborns admitted to and discharged from one newborn nursery from September 1, 1992, to May 1, 1994. All visits in the first 90 days of life to one large urban ED were analyzed to determine whether they were nonurgent, based on history of present illness and final diagnosis or disposition. The principal outcomes of interest were the frequency and pattern of nonurgent ED visits. Risk factors for nonurgent ED use were also studied. Results A total of 2137 patients with 965 ED visits were analyzed; 20.4% of the patients had nonurgent visits, and 60.1% of all visits were nonurgent. Of all patients with nonurgent visits, 24.1% had more than one. Younger maternal age, Medicaid, maternal parity, and nonwhite race all resulted in increased nonurgent ED use. One third of all ED visits were made when the primary care physician’s offices were open, and 57.6% of these visits were nonurgent. Conclusions Maternal and economic factors affected nonurgent ED utilization. Other critical factors still need to be explored. Interventions focused on decreasing nonurgent ED use in early infancy should be targeted at patients with the identified risk factors.

Quality-Improvement Initiative Sustains Improvement in Pediatric Health Care Worker Hand Hygiene

OBJECTIVE To assess the effect of an early discharge program on the use of hospital-based health care services in the first 3 months of life. DESIGN Retrospective cohort study. SETTING Metropolitan university hospital and a childrens hospital. PATIENTS Term infants cared for in a single term nursery, before and after implementation of an early discharge program. INTERVENTION Early discharge program. METHODS Linking of the birth hospital and the childrens hospital records and chart review. OUTCOME MEASURES Pattern of emergency department visits and rehospitalizations in the first 3 months of life. RESULTS The early discharge group had a shorter stay, 32 +/- 21 hours (mean +/- SD) than the control group (48 +/- 22 hours). There was no effect of early discharge on mean age at rehospitalization, rehospitalization rate, or reason for rehospitalization. Twenty-eight percent of infants in both study and control groups had at least one emergency department visit by 3 months of age. There was no difference between study and control groups in mean age or frequency of emergency department visits. Maternal age and race had a significant effect on the odds of visiting the emergency department. For any maternal age, nonwhite mothers were more likely to visit the emergency department. CONCLUSIONS Early discharge of newborn infants to inner city parents can be accomplished without increasing hospital-based resource use in the first 3 months of life provided coordinated postdischarge care and home visiting services are available.

Effect of insulated skin probes to increase skin-to-environmental temperature gradients of preterm infants cared for in convective incubators☆☆☆★

BACKGROUND Guidelines for preventing and treating acute gastroenteritis (AGE) have generally not been incorporated into medical practice. An evidence-based clinical practice guideline was adapted from national guidelines to meet the practice styles characterizing care in southwestern Ohio and implemented at the Childrens Hospital Medical Center (Cincinnati). Its efficacy was assessed in terms of emergency department (ED) encounters and admissions, mean and total hospital costs, and mean length of hospitalization. METHODS Comparisons were made between patients seen during peak gastroenteritis months (December-May) before (fiscal year [FYs] 1994-1997) and after (FYs 1998 and 1999) guideline implementation. Data were extracted from hospital charts, clinical databases, and billing records. RESULTS Following implementation, mean yearly ED encounters for AGE decreased 22% and mean yearly admissions decreased 33%. The percentage of admitted children with minor illness decreased (p = 0.002). Mean length of stay decreased 21% for children with minor illness (p = 0.0001) and 5% for others. Hydration status was noted in only 15% of ED charts examined but increased to 63% in FY 1998 and 86% in FY 1999 (p < 0.001). The proportion of admitted patients who advanced to a regular diet by discharge increased from 4.9% (FY 1997) to 23% (FY 1998) and 76% (FY 1999; p < 0.0001). Total inpatient days/year decreased by 43%. Mean hospital costs did not change significantly. DISCUSSION Following implementation, fewer patients with AGE were seen in the ED and fewer were admitted to the hospital for care. Hospital stays were shorter, and children were more likely to resume their diets before discharge.