Evidence to recommend specific timing for the initial postdischarge assessment is not strong. SNF Discharge Planning; A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility (42 C.F.R. However, identification of some problems may require longer observation. METHODS: A stratified random sample of charts from newborns who were … A major study of 38,958 patients after ambulatory surgery found that the risk of dying … Understanding newborn infant readmission: Findings of the Ontario mother and infant survey. Antigonish, NS: St. Francis Xavier University, December 2009. http://nccdh.ca/images/uploads/TK_KeyFactsGlossaryJune25_v61.pdf (Accessed May 8, 2018). On May 17, 2013, the Centers for Medicare & Medicaid Services (CMS) released an update of Appendix A of the State Operations Manual (SOM) revising its interpretive guidelines for hospital Discharge Planning. Healthy term infants should be considered ready for discharge home when all criteria in Table 1 have been met. Eur J Pediatr 2012;171(1):167–71. Can J Public Health 2002;93(4):276–80. https://www.raredisorders.ca/content/uploads/Canada-NBS-statusupdated-Sept.-3-2015.pdf (Accessed May 7, 2018). The Freeman Hospital has developed guidelines to assist all nursing staff working in the recovery area who are responsible for the care of patients in the immediate postoperative period, particularly those staff who are less experienced. A randomized comparison of home and clinic follow-up visits after early postpartum hospital discharge. Variations, taking into account individual circumstances, may be appropriate. As with invasive procedures such as central venous catheterization, the first step of the discharge process is to obtain consent, which includes discussing its risks and benefits. Variations from normal in the infant’s behaviour should be noted, communicated to the responsible HCP and followed up as required. Scientific World Journal 2003;3:1363–9. Going home: Facilitating discharge of the preterm infant. BMJ 1999;318(7184):627–31. Hospital discharge service guidance Guidance on how health and care systems should support the safe and timely discharge of people who no longer need to stay in hospital… It is important that these plans and protocols be tailored to meet the individual needs of each mother–infant dyad and family. van Dommelen P, van Wouwe JP, Breuning-Boers JM, van Buuren S, Verkerk PH. The safety of early postpartum discharge: A review and critique. Some infants are candidates for vaccination before discharge. Safe Discharge from Hospital Always make sure at least one family member or friend is present when you review your specific discharge instructions with your doctor and nurse. Several studies … Turowski C, Dingemann J, Gillick J. endobj Management of term infants at increased risk for early onset bacterial sepsis. Am J Dis Child 1984;138(11):1041–6. A complete physical examination of all newborns, performed during the first 24 h to 72 h of life before discharge, is standard practice in North America and elsewhere. At the time of discharge home, parents of preterm infants in the neonatal intensive care unit often feel apprehensive and may question their ability to care for their baby. Bright futures. Cochrane Database Syst Rev 2017;8:CD009326. Jackson GL, Kennedy KA, Sendelbach DM et al. A consistent approach to education and discharge planning can enhance parental satisfaction and confidence and decrease confusion and stress. Infant temperature is stable: in an open cot, with the newborn appropriately dressed. A structured checklist can help to document findings and ensure that the examination is complete (see Appendix). 2. Discharge criteria, inclusive of a post anesthetic recovery score system The HCP should assess and note parent–infant interaction, ask how the family is coping and inquire about any psychosocial or socio-economic stressors. The hospital’s policies and procedures must be specified in writing. All parents should receive counselling on infant care, signs of illness and how to respond, and infant safety, including safe sleep practices. 100-2305 St. Laurent Blvd Ottawa, ON Canada K1G 4J8, info@cps.ca (613) 526-9397 (613) 526-3332. The overall safety record of modern ambulatory anesthesia is impressive , with major morbidity and mortality being extremely rare . Verify here. 7. For permission to reprint or reproduce multiple copies, please see our copyright policy. A randomized trial of single home nursing visits vs office-based care after nursery/maternity discharge: The nurses for infants through teaching and assessment after the nursery (NITTANY) study. Chen YJ, Chen WC, Chen CM. Preparation for discharge should be part of antenatal education for all expectant mothers and should include information on feeding, routine newborn care and infant safety. The Rourke Baby Record provides guidance on specific items to include with the physical assessment during the first week of life [29]. Pulse oximetry screening for critical congenital heart disease (CCHD) is now recommended for term infants before discharge. Appropriate electronic resources, such as www.caringforkids.cps.ca or www.aboutkidshealth.ca should be recommended. Examination of the Newborn: An Evidence-based Guide, 2nd edn. Zimmerman DR, Klinger G, Merlob P. Early discharge after delivery. Shakib J, Buchi K, Smith E, Korgenski K, Young PC. Jefferies A; Canadian Paediatric Society, Fetus and Newborn Committee. Objective: The aim of this study is to achieve an international consensus on hospital discharge criteria for patients undergoing colorectal surgery. Whyte RK; Canadian Paediatric Society, Fetus and Newborn Committee. There is no conclusive evidence to demonstrate whether a shorter hospital LOS increases risk to infant health or to establish the ideal LOS for healthy term newborns. When the mother is breastfeeding, arrangements for monitoring the infant’s weight and postdischarge lactation support must be made. Shaw BA, Segal LS, American Academy of Pediatrics, Section on Orthopedics. <>/Metadata 340 0 R/ViewerPreferences 341 0 R>> Neonatal bowel obstruction. JAMA Pediatr 2014;168(4):361–70. Several studies have shown that approximately 50% to 95% of problems necessitating transfer to a higher level of care or readmission after discharge were detected during the first 24 h of life [11]–[13]. Most newborn care guidelines recommend a postdischarge assessment by an HCP within the first week of life. Because some newborn problems may not be apparent early on, it is prudent to re-examine infants assessed during the first 6 h of age. The specific hospital length-of-stay (LOS) for healthy term (≥37 weeks’ gestational age (GA)) newborns depends on the health of the mother, infant health and stability, the mother’s ability to care for her infant, support at home, and access to follow-up care. Flaherman VJ, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM, Paul IM. avoidable adverse events expressed as falls (1 study, very low quality), length of stay (5 studies, moderate quality), quality of life SF-12 mental ratings (1 study, very low quality) patient and/or carer. Three studies have suggested that hospital readmission and emergency room visits are reduced when newborns are seen within a few days of discharge [54]–[56], whereas one found that assessments completed within 3 days of discharge have little impact on these outcomes [57]. Lavagno C, Camozzi P, Renzi S, et al. Physical examination (including head circumference and length) by a health care provider is complete and documented, with no additional in-hospital or ongoing observations or treatments needed. Hospital stay for healthy term newborn infants. Robinson JL; Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Analogy for steps that facilitate safe ED discharge processes. Members: Heidi Budden MD (Board Representative), Mireille Guillot MD (Resident member), Leonora Hendson MD, Ann L. Jefferies MD (past Chair), Thierry Lacaze-Masmonteil MD (past Chair), Brigitte Lemyre MD, Michael Narvey MD (Chair), Leigh Anne Newhook MD (past Board Representative), Vibhuti Shah MD, Liaisons: Radha Chari MD, The Society of Obstetricians and Gynaecologists of Canada; James Cummings MD, Committee on Fetus and Newborn, American Academy of Pediatrics; William Ehman MD, College of Family Physicians of Canada; Roxanne Laforge RN, Canadian Perinatal Programs Coalition; Chantal Nelson PhD, Public Health Agency of Canada; Eugene H. Ng MD, CPS Neonatal-Perinatal Medicine Section; Doris Sawatzky-Dickson RN, Canadian Association of Neonatal Nurses; Kristi Watterberg MD, Committee on Fetus and Newborn, American Academy of Pediatrics (past representative), Principal authors: Brigitte Lemyre MD, Ann L. Jefferies MD, Pat O’Flaherty MEd, MN, RN-EC. Gastrointestinal obstruction and hyperbilirubinemia requiring treatment are not always clinically apparent within 24 h of birth [14][15]. Table 1 should be customized for specific hospital and health region policies, because requirements and programs vary considerably by jurisdiction. Aziz K, Dancey P; Canadian Paediatric Society, Fetus and Newborn Committee. Paediatr Child Health 2011;16(5):301–5. Brown S, Small R, Faber B, Krastev A, Davis P. Early postnatal discharge from hospital for healthy mothers and term infants. Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th edn Elk Grove Village, IL: American Academy of Pediatrics, 2014. Antenatal and perinatal infant risk factors including (but not limited to) sepsis, neonatal abstinence syndrome, jaundice and hypoglycemia, should be evaluated and monitored. J Perinatol 2010;30(Suppl):S6–15. Internet addresses are current at time of publication. Physical findings for infants examined during the first 6 h of life may vary as these infants transition [22], and functional heart murmurs are heard more frequently when the infant is examined early [23]. Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants. Joint Statement on Safe Sleep: Preventing Sudden Infant Deaths in Canada, 2011. http://www.phac-aspc.gc.ca/hp-ps/dca-dea/stages-etapes/childhood-enfance_0-2/sids/pdf/jsss-ecss2011-eng.pdf (Accessed May 7, 2018). Senior Consultant, Medical Fellow, Visiting Medical Officer). The authors concluded that same-day discharge is safe for patients with suspected or biopsy-proven MH after uncomplicated ambulatory surgery. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 22 0 R 27 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Impact of newborn follow-up visit timing on subsequent ED visits and hospital readmissions: An instrumental variable analysis. Bernstein HH, Spino C, Finch S et al. An abnormality is detected in approximately 8% to 10% of newborns [24][25]. Examples of interventions that help to ensure a safe transition from the hospital include discharge planning, medication reconciliation, patient education, follow-up appointment scheduling, communication with community partners, and summaries of care given in the hospital. Up to 30% of nonsyndromic critical congenital heart disease may not be diagnosed definitively during the first 3 days of life, although the presence of cardiac disease may have been recognized [16]. Make sure there are fresh groceries at home in preparation for discharge. Each infant must have an appropriate discharge plan, including identification of the infant’s primary health care provider and assessment by a health care provider 24 h to 72 h after discharge. Guidelines need to be in place to help nurses in the 12. Acad Pediatr 2013;13(1):27–39. CMS has revised guidelines for the discharge planning condition of participation in the State Operations Manual. Clin Pediatr (Phila) 2000;39(10):581–90. Jefferies AL; Canadian Paediatric Society, Fetus and Newborn Committee. Gagnon AJ, Dougherty G, Jimenez V, Leduc N. Randomized trial of postpartum care after hospital discharge. Healthy term newborns should remain in hospital long enough to allow identification of major problems. {}������`I�&�6��er� Bacille Calmette-Guerin (BCG) vaccine can be considered for infants in high-risk communities or born to mothers with infectious tubercular disease [49]. Lomax A, editor. A study of safety and risk factors. Consent. Weight loss in excess of 10% increases the risk of hyperbilirubinemia [31][32] and hypernatremia [33][34]. Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed. Background The safe discharge planning process begins as soon as the patient arrives in the ED. Public Health Agency of Canada. © 2020 Canadian Paediatric Society. Given that the geometric mean of hospital charges per child with bronchiolitis increased from $6380 in 2000 to $8530 in 2009, the potential for safely reducing hospital LOS by using the discharge criteria proposed in the current study instead of other criteria may net substantial cost savings. The development of the document was driven by the decision to provide written information that staff could use both in recovery and in theatre, to ensure consistency of care. Delayed diagnosis of imperforate anus: An unacceptable morbidity. Postpartum discharge preferences of pediatricians: Results from a national survey. Urine and at least one stool have been passed. The CPS, Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association now recommend that pulse oximetry screening (POS) for congenital heart disease be routinely performed in healthy term newborns. 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