Timely Discharge Program
Goal: Simplify/Clarify the criteria to determine who is a candidate for early discharge and expedite these discharges with appropriate outpatient follow-up. Recognize that many “normal” newborns have too many risk factors to safely discharge them from the hospital in less than 48 hours.
1) Low risk newborns and their mothers born before 6:00pm on any given day may be eligible for a next day discharge as of 24 hours of age. (See criteria below) These infants need outpatient follow-up within 48 hours.
2) Normal newborns and their mothers with risk factors will be discharged when these factors can be addressed appropriately and it is medically safe to do so. These families should anticipate a 48 hour stay. Outpatient follow-up appointments will be made based on medical need.
3) Mother-Baby pairs that do not meet timely discharge criteria but the family insists on an early discharge must have the risk explained to them and a note documenting the discharge plan in the chart. These infants should all have early follow-up appointments made
Antepartum/Intrapartum Course (should include but is not limited too)
a) Uncomplicated vaginal birth
b) Gestational Diabetes is okay if all the infant’s chemstrips are okay
c) Insulin dependent pre-gestational diabetes is not a candidate for TD
d) No pre-eclampsia requiring medical management
e) No meconium below the cords
f) No 5 minute apgar <7
g) No cord gases <7.1
h) Assisted vaginal birth okay if above met
Social - Recommend Social Work Eval Prior to D/C
a) Current (within last 2years) untreated parental substance abuse
b) All positive toxicology screens
c) History of domestic violence in current relationship/pregnancy
d) Lack of social support
e) Lack of housing
f) Maternal mental illness
g) Family with history of child abuse, CFS involvement
h) Limited prenatal care (<4visits) with other risks
i) Concern of mother’s ability to care for infant
j) Considering relinquishment
k) Special consideration for 1st time moms and teen moms
Newborn Course
a) Must be term infant between 38 – 42 weeks gestation
b) Must be appropriate for gestational age (weight 2750 – 4100 gms)
c) If breastfeeding, need latch > 7 times two
d) If bottlefeeding, need two feeds of 30cc minimum
e) Must have voided and stooled
f) Stable vital signs for the 12hours prior to d/c (HR 100 – 160, RR<60, T = 97.7 – 99.3)
g) Amount of weight loss assessed
h) No concerns of significant hyperbilirubinemia
i) No pending labs
j) Education complete
k) Mother’s post-partum course uncomplicated
l) No outstanding infectious issues.
Highlights of Changes
1) Narrower normal temp range CCRMC currently 97.6 – 99.6, AAP
97.7 – 99.3
2) If baby is born from noon on and is being considered for early discharge the next day, he/she will need to be weighed again at noon of day of discharge
3) All babies < 38 weeks will get a ballard to determine actual gestational age. 37 weeks is not term.
4) All babies < 2750 grams and greater than 4100 grams will get a ballard to determine actual gestational age. The terms borderline SGA and LGA will no longer be acceptable
Other Key Points Regarding Discharges
1.) Billing forms need to be filled out daily for nursery babies, and for the admissions/discharges of well babies.
2.) Discharge summaries need to be dictated for infants with hospital stay longer than 72 hours or for those who have been through the nursery.
3.) For patients with significant weight loss (>8%) that affects disposition, recalculate the weight loss percentage to make sure what’s documented is correct. Document reweigh in H&P and discharge summary before discharge. Any patient with >8% weight loss should have a brief daily note written.
4.) For patients with murmurs at the time of discharge, a simultaneous pre- and post-ductal O2 Sat and 4-limb BPs should be obtained. This should be documented in the H&P. Decision regarding referral to Cardiology should be discussed with the attending.