Evaluation of obstetric early discharge - reasons for non-participation, CHERE Discussion Paper No 11

An Early Discharge Program (EDP) for medically uncomplicated obstetrics patients operates from three hospitals in Sydney's western suburbs, Westmead Hospital, a large teaching hospital, and Auburn and Blacktown, which are smaller district hospitals. The patients are discharged home between 6 and 48 hours after delivery and visited in the home by midwives for up to 7 days after birth. This program is funded under the Medicare Incentive Package, one of the objectives of which is to facilitate the development of less costly alternatives to acute hospital care. An economic analysis and evaluation of the EDP was carried out at the same time as this study, to examine the net economic value of resources released due to the EDP. As a considerable proportion of obstetric patients who are eligible for this program decline to take it up, this study investigated the reasons these women had for choosing to remain longer in hospital, rather than going home early with domiciliary midwifery support. On the day before discharge, the patients were asked to complete a self administered questionnaire, giving their reasons for refusing the EDP, an assessment of the costs incurred by their stay in hospital to themselves and their visitors, and their satisfaction with the post natal care received. This study showed an apparent lack of awareness and information about the EDP among the patients, particularly those with non-English speaking backgrounds. It also showed that a substantial proportion of the women had no help at all with housework and child care and would have used EDP if more home help was available. One outstanding characteristic which distinguished EDP participants and non-participants was parity. A higher proportion of women who chose not to take early discharge were first time mothers. This reflected their lack of confidence, experience and information about baby care and possibly their low expectations of postnatal health. In order to increase participation rates in EDP this report recommends that: fuller information and educational programs be used to raise awareness of EDP; there be an increased availability of home help; and a "hot line" be set up providing women with instant access to advice. It also suggests a single day reduction in length of hospital stay instead of the usual 2 or 3 days required by this EDP.