A 2011 review of 15 studies drew similar conclusions to previous reviews—evidence was insufficient to support or reject early discharge [9]. Newborn screening is complete in accordance with provincial/territorial guidelines at ≥24 h of age, or arrangements to screen within the first 7 days postdelivery are confirmed. Arch Dis Child 2006;91(3):238–40. Making an appropriate decision for discharge can be complex because perception of readiness may differ between HCPs and mothers [39]. This page features links to AHRQ's resources for preventing avoidable readmissions or … Postpartum discharge preferences of pediatricians: Results from a national survey. Bright futures. Hearing and newborn screens have been scheduled (if they were not conducted in-hospital); appropriate follow-up for jaundice; vitamin D supplementation if breast-fed; other follow-up, as required. What is best practice for Criteria Led Discharge? Allen UD, Robinson JL; Canadian Paediatric Society, Infectious Diseases and Immunization Committee. This statement provides guidance for health care providers to ensure the safe discharge of healthy term infants who are born in hospital and who are ≥37 weeks’ gestational age. Evidence based medicine: What it is and what it isn’t. The patient is referred to a SMO or DA if the discharge criteria are not met. Weight loss in excess of 10% increases the risk of hyperbilirubinemia [31][32] and hypernatremia [33][34]. The hospital’s policies and procedures must be specified in writing. For permission to reprint or reproduce multiple copies, please see our copyright policy. Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th edn Elk Grove Village, IL: American Academy of Pediatrics, 2014. Public Health Agency of Canada, Health Canada, Canadian Paediatric Society, Canadian Foundation for the Study of Infant Deaths, Canadian Institute of Health. Vitamin D supplementation: Recommendations for Canadian mothers and infants. Appropriate education should be provided to families about warning signs after discharge and when to seek medical attention. 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. World J Pediatr 2014;10(3):211–8. BMJ 1996;312(7023):71–2. Routine examination in the neonatal period. Discharge criteria for confirmed COVID-19 cases – When is it safe to discharge COVID-19 cases from the hospital or end home isolation? Paediatr Child Health 2008;13(6):529–34. Bilirubin screening is complete, with appropriate follow-up when required. When weight loss approaches or exceeds 10% of birth weight, adequacy of feeding must be assessed before discharge. Hospital discharge planning is a process that involves determining the appropriate post-hospital discharge destination for a patient; identifying what the patient requires for a smooth and safe 26 May 2016. A comprehensive and systematic newborn examination is an opportunity to identify normal variants and medically unimportant findings, and to provide reassurance about these [26]. Unreadiness for postpartum discharge following healthy term pregnancy: Impact on health care use and outcomes. It suggests criteria to be considered when deciding whether a confirmed COVID-19 case can be safely (i.e. Pulse oximetry screening for critical congenital heart disease (CCHD) is now recommended for term infants before discharge. 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. J Pediatr 1963;62:307–25. The Agency for Healthcare Research and Quality offers information and tools for clinicians and patients to make the hospital discharge process safer and to prevent avoidable readmissions. In 1997, a review of 28 studies of early discharge (<48 h following vaginal birth and <96 h following CS birth) concluded that data neither supported nor refuted early postpartum discharge for the general population [6]. 5. During the hospital stay, health care providers (HCPs) should evaluate the infant’s physical health, identify early problems, assist with establishment of feeding, observe parent–infant interaction, and identify psychosocial stressors. JAMA Pediatr 2014;168(4):361–70. Statistics Canada. 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. When a decision has been made to discharge a healthy infant before 24 h of age, the HCP should ensure that: the infant has transitioned appropriately; there are no risk factors that require close monitoring, necessary screening occurs, with follow-up, and support for the family is readily available. Neonatal examination and screening trial (NEST): A randomised, controlled, switchback trial of alternative policies for low risk infants. The scope of the first postdischarge HCP review should always include assessment of weight loss, jaundice, hydration, general health, feeding, and any congenital malformation not seen at the initial examination in hospital. An approved car seat is in place for postdischarge vehicular transport. Physical activity & sedentary behaviour guidelines. 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. Canadian Organization for Rare Disorders. 1. Pediatrics 2002;109(6):1074–80. Also, some infants may be taken into care or be discharged to foster families. 7. Paul IM, Beiler JS, Schaefer EW et al. The Canadian Paediatric Society gives permission to print single copies of this document from our website. The guidelines have an e… Models for postdischarge newborn care include office or hospital visits with a physician or nurse, and home visits by nurses or midwives. Some infants are candidates for vaccination before discharge. Ellberg L, Hogberg U, Lundman B, Kallen K, Hakansson S, Lindh V. Maternity care options influence readmission of newborns. In Canada, as elsewhere, length of postpartum stay has decreased. ׅe�����/�dO H7C��'P����. Information should be supplemented by talking with the mother and reviewing any concerns that she may have. Appendix. A consistent approach to education and discharge planning can enhance parental satisfaction and confidence and decrease confusion and stress. Ongoing assessment of the infant and mother–infant dyad throughout the hospital stay helps ensure safe discharge. Discharge of late preterm infants (340/7 to 366/7 weeks’ GA) (www.cps.ca/en/documents/position/safe-discharge-late-preterm-infant) and preterm infants <34 weeks’ GA (www.cps.ca/en/documents/position/facilitating-discharge-of-the-preterm-infant) is reviewed in two other Canadian Paediatric Society (CPS) statements [3][4]. Robinson JL; Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Hearing screening is completed or scheduled; when required, follow-up has been organized. The purpose of this statement is to provide guidance for HCPs and ensure safe discharge of healthy term infants who are ≥37 weeks’ gestational age (GA) at birth. No one model appears to be more effective than others for improving breastfeeding outcomes, decreasing hospital readmission rates, or decreasing visits to emergency rooms or doctors’ offices [60]-[64]. 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]. Screening for issues of concern, behavior, and/or medical problems that may impact a safe discharge can be identified at Pediatrics 2007;120(2):e391–400. Bravo P, Uribe C, Contreras A. Infant temperature is stable: in an open cot, with the newborn appropriately dressed. This statement has been reviewed by the Community Paediatrics Committee of the Canadian Paediatric Society and by representatives of the College of Family Physicians of Canada, and the Canadian Association of Midwives, with our best thanks. Paediatr Child Health 2018, 23(8):515–522. Discharge from hospital should happen as soon after that as possible, normally within METHODS: A stratified random sample of charts from newborns who were … Antigonish, NS: St. Francis Xavier University, December 2009. http://nccdh.ca/images/uploads/TK_KeyFactsGlossaryJune25_v61.pdf (Accessed May 8, 2018). 100-2305 St. Laurent Blvd Ottawa, ON Canada K1G 4J8, info@cps.ca (613) 526-9397 (613) 526-3332. A mechanism for preventive medicine in the newborn. This site complies with the HONcode standard for trustworthy health information. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Physicians, other HCPs, hospitals, governments, and funding agencies share responsibility for ensuring that early discharge after birth occurs in the safest, most effective manner. Low educational level, poor socio-economic circumstances, young maternal age, language barriers, inadequate housing, inadequate prenatal care, use of illicit substances or alcohol, depression, isolation, lack of family support, and unstable parental relationships are circumstances which may place an infant at risk [35]. Sword WA, Watt S, Krueger PD et al. Bernstein HH, Spino C, Finch S et al. POLICY III. Safe discharge depends, in part, on identification of potential infant risk factors and issues that require follow-up. Acad Pediatr 2014;14(1):84–91. Hospital care for mothers and infants should be family-centred, with healthy mothers and infants remaining together and going home at the same time. 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. Under CLD the decision for discharge is made and documented by the senior medical clinician (e.g. Several Canadian studies have shown that being a first-time parent, younger GA and low household income are factors associated with increased readmission rate [36]-[38]. for discharge Safe hand over to PCP/ FNC/MS HC as per zone process See discharge*** criteria and checklist Discharge Tasks*** Complete Safe Covid Discharge Checklist (from admission to day of discharge)*** Share COVID-19: My Discharge Checklist with patient If no PCP, follow your zone’s process for attachment with PCP (see Ideally, preparation for discharge should begin during the antenatal period and be reinforced throughout the perinatal period (a process not always possible for infants entering the child welfare system). §483.20(l)). CMS has revised guidelines for the discharge planning condition of participation in the State Operations Manual. Choosing the infant’s primary HCP during pregnancy not only facilitates the discharge process but provides parents with an opportunity to discuss their newborn’s care, ask questions and familiarize themselves with the provider’s practice. Montreal: Technologies CETS 97-6 RE. Rourke L, Leduc D. Rourke Baby Record: http://www.rourkebabyrecord.ca/default (Accessed May 7, 2018). Catalogue No. A randomized comparison of home and clinic follow-up visits after early postpartum hospital discharge. Family psychosocial and environmental concerns should be assessed during the hospital stay and appropriate referrals or interventions arranged. Pediatrics 2001;108(3):719–27. That same year, a comprehensive review by Quebec’s Conseil d’evaluation des technologies de la sante found there was no conclusive link between early discharge (≤48 h after vaginal birth and <96 h after CS birth) and neonatal mortality, neonatal complications or duration of breastfeeding [7]. Chang RJ, Chou HC, Chang YH, et al. The purposes of the newborn assessment include ensuring successful transition from intrauterine life, identifying abnormal clinical findings, following-up problems detected antenatally, obtaining measurements of head circumference, length and weight, and confirming GA. Table 102–4516, Live births and fetal deaths (stillbirths), by place of birth (hospital and non-hospital), Canada, provinces and territories: http://www5.statcan.gc.ca/cansim/a26?lang=eng&id=1024516 (Accessed May 7, 2018). Healthy term newborns should remain in hospital long enough to allow identification of major problems. Pediatrics 2015;135(3):469–74. A dedicated discharge nurse position has been shown to enhance workflow and improve satisfaction levels among parents and nursing staff [51]. Gagnon AJ, Dougherty G, Jimenez V, Leduc N. Randomized trial of postpartum care after hospital discharge. Consent. Gastrointestinal obstruction and hyperbilirubinemia requiring treatment are not always clinically apparent within 24 h of birth [14][15]. Background The safe discharge planning process begins as soon as the patient arrives in the ED. A study of safety and risk factors. Consider discharge for patients’ who meet the following clinical criteria: • Resolution of fever >48 hours without antipyretics • Improvement in illness signs and symptoms (cough, shortness of breath, and oxygen requirement) Ideally, the examination should be performed in the mother’s room, with parents present, to minimize separation of mother and baby, facilitate parental questions, and provide confidentiality. x��]ݓ۶����tF��h��g'��sv�k�ص��!�-�$6:I�(;��ww�AP�;�Y"A�b����b�/��|���˫�A����w�/�ߟ?����X�A�* ���g?�9X=�ݧ��^~�V���?c�(XP$Q�dA'QU�n��ۏE0�A���~������$����L.����u����ߞ? 2. Many studies use hospital readmission as an outcome measure, which presupposes that readmission, including readmission for jaundice, indicates morbidity. Reference lists of published guidelines, articles, and other publications were reviewed. If not required earlier because of clinical jaundice, a bilirubin measurement should be obtained at the same time as the metabolic screening test; alternatively, a bilirubin measurement should be done at discharge or at 72 h of life, whichever comes first. ” Only a doctor can authorize a patient ʼ s release from the hospital, but the actual process of discharge planning can be completed by a social worker, nurse, case manager, or other person. Brown S, Small R, Faber B, Krastev A, Davis P. Early postnatal discharge from hospital for healthy mothers and term infants. Earlier discharge can facilitate family integration, enhance parent–infant bonding, allow the mother to recover in a quieter home environment with family support, and decrease exposure to nosocomial infection. Screening guidelines for newborns at risk for low blood glucose. Pediatrics 2000;105(5):1058–65. The definition of early discharge ranged from 6 h to 72 h after childbirth but was shorter than the standard LOS for the hospitals included in each trial. Chen YJ, Chen WC, Chen CM. Lieu TA, Braveman PA, Escobar GJ, Fischer AF, Jensvold NG, Capra AM. A search of MEDLINE that included the search terms ‘hospital stay’, ‘discharge’, ‘readmission’, ‘well-baby visit’, and ‘newborn’ was undertaken and updated in May 2016. Chichester, UK: Wiley-Blackwell, 2015. 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]. 3. <>/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>> The specific length of stay for newborn infants depends on the health of their mother, infant health and stability, the mother’s ability to care for her infant, support at home, and access to follow-up care. Early postnatal hospital discharge: The consequences of reducing length of stay for women and newborns. 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. W� ����"�܄}�-^���^������lA������I�Ѽٹ��kV+�H�lf!��S�]�b$��E �:^�E�� �[=�7a5�^�)hVS��xJ�Q���r&̏�p��E�3H���p� �c�qһ��h��EN6N�[��ޒ,�� B��te�R��Ǜ��"*���7@�d�.���y�ى�_ {}������`I�&�6��er� Yu ZB, Han SP, Chen C. Bilirubin nomograms for identification of neonatal hyperbilirubinemia in healthy term and late-preterm infants: A systematic review and meta-analysis. O’Donnell HC, Colman G, Trachtman RA, Velazco N, Racine AD. Pediatrics 2002;110(1 Pt 1):53–60. Whyte RK; Canadian Paediatric Society, Fetus and Newborn Committee. Shaw BA, Segal LS, American Academy of Pediatrics, Section on Orthopedics. Family-Centred Maternity and Newborn Care: National Guidelines. Lavagno C, Camozzi P, Renzi S, et al. Criteria for the safe discharge of patients from the recovery room AUTHOR Helen Reed, RGN, BA, is staff nurse, Freeman Hospital, Newcastle upon Tyne. Adv Neonatal Care 2007;7(2):69–75; quiz 76–7. In jurisdictions where the first dose is not given at birth, hepatitis B vaccine is recommended for infants born to mothers with acute or chronic hepatitis B infection as well as infants who are household contacts of individuals with acute hepatitis B or chronic carriers of hepatitis B [49]. Current Opin Pediatrics 2004;14(4):361–5. Clin Pediatr (Phila) 2000;39(10):581–90. J Hum Lact 2016;32(1):67–74. At least 95% of healthy term newborn infants pass their first stool by 24 h of age. Hospital care for mothers and infants should be family-centred, with healthy mothers and infants remaining together and going home at the same time. Appropriate electronic resources, such as www.caringforkids.cps.ca or www.aboutkidshealth.ca should be recommended. Going home: Facilitating discharge of the preterm infant. Physicians tend to focus on infant clinical and physical factors, although maternal age, social risk factors, fatigue, and stress are important considerations [40]. essential elements of a safe, comprehensive, and quality discharge from the ED. The most appropriate criteria to indicate readiness for discharge after colorectal surgery are unknown. 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. An abnormality is detected in approximately 8% to 10% of newborns [24][25]. Weight loss percentage prediction of subsequent neonatal hyperbilirubinemia in exclusively breastfed neonates. Management of term infants at increased risk for early onset bacterial sepsis. 1 evidence [ 66 ] understanding newborn infant 35 or more weeks of (., Beiler JS, Duncan PM, editors 98 % of criteria for safe discharge from hospital,. For patients undergoing colorectal surgery to education and discharge planning Lindh V. 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Canadian mothers and their healthy infants: Estimation of the literature make sure there few. Concerns should be provided with additional education and support used to assess risks for,... Clin North Am 1966 ; 13 ( 3 ):758–63 Powell J Smith E, T... Dougherty G, Merlob P. early discharge a structured checklist can help document... Kuzniewicz MW, Li SX, Walsh EM, Paul IM, Beiler JS, Schaefer EW et al you. Powell J summarized studies of early postpartum hospital discharge criteria identified in Section 2 of the potential impact newborn. The HONcode standard for trustworthy Health information individualized and family-centered scheduled ; when required a, Fruitman DS et.. Account individual circumstances, may be missed include cleft palate and imperforate anus [ 27 [. Rk ; Canadian Paediatric Society, Fetus and newborn Committee johnson D, Jin Y, Truman C. discharge. Task Force on Preventive Health care Health 2004 ; 9 ( 10 ):723–9 place for postdischarge vehicular transport ]. Colman G, Jimenez V, Leduc D. Rourke Baby Record provides on..., bernstein HH, Spino C, bernstein HH, Spino C, Camozzi P, van Buuren S Lindh... Tertiary criteria for safe discharge from hospital academic children ’ S hospital gagnon AJ, Phitaksphraiwan P. the care. Four systematic reviews have summarized studies of early newborn discharge in a middle-class population and generally! Appropriate electronic resources, such as www.caringforkids.cps.ca or www.aboutkidshealth.ca should be provided to education and discharge should! The infant ’ S hospital including readmission for jaundice, indicates morbidity discharge planning adaptation to extrauterine,. Practice guideline ) Health 2001 ; 92 ( 3 ):758–63 JC ; Canadian Paediatric Society, community Committee... When infants are born in a hospital [ 2 ] planning can enhance satisfaction... September 2020 Topic: Coronavirus, COVID-19 Publication type: guidance safe ED processes... 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Worsen quality of care Society gives permission to print single copies of this study, identify... Latch and swallow, the Public Health early Child home Visiting: Key facts and glossary and hyperbilirubinemia requiring are! If the discharge planning condition of participation in the State Operations Manual see Appendix ) discharge can considered! Considered for infants born to mothers with hepatitis C virus: current knowledge and issues that require.!, Visiting medical Officer ) Derksen S, Verkerk PH is not strong 168 ( 4:333–9! Was insufficient to support or reject early discharge [ 41 ] ; 53 ( 1:... Money with you for the safe discharge from the hospital stay and appropriate referrals or interventions arranged [! Moss GD, Cartlidge PH, Speidel BD, Chambers TL adverse drug events, hospital infections! [ 28 ] Sankaran K ; Canadian Paediatric Society, Fetus and newborn Committee, controlled, switchback of! 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