Are Families Prepared for Discharge From the NICU?
Objective: (1) Quantify and compare the family's and the nurse's perception regarding the family's discharge preparedness. (2) Determine which elements contribute to a family's discharge preparedness.
Study Design: We studied the families of all the infants discharged from a neonatal intensive care unit after a minimum of a 2-week admission. The families rated their overall discharge preparedness with a 9-point Likert scale on the day of discharge. Independently, the discharging nurse evaluated the family's discharge preparedness. Families were considered discharge 'prepared' if they rated themselves and the nurse rated their technical and emotional preparedness as ≥7 on the Likert scale.
Result: We had 867 (58%) family–;nurse pairs who completed the survey. Most families (87%) were prepared for discharge as assessed by the concordant questionnaire (Likert scores of ≥7 by the parent and the nurse). In multivariate analysis, confidence in their child's health and maturity (odds ratios, OR = 2.5 95% confidence interval, CI (1.2, 5.3)), their readiness for their infants to come home (OR = 2.9 95% CI (1.0, 8.3)), and selecting a pediatrician (OR = 4.2 95% CI (1.6, 11.0)) were statistically significant.
Conclusion: Assistance with pediatrician selection and home preparation may improve the percentage of families prepared for discharge.
Discharge preparation in the neonatal intensive care unit (NICU) is critically important. Even for families with healthy term infants, poor discharge preparation has been linked to problems at home and increased unscheduled health care use. Poor discharge planning has the potential for even worse outcomes for preterm infants because of their poor cues to needs and ongoing medical problems after hospital discharge, in particular, those with lung disease and others at the highest risk for rehospitalization.
Rehospitalization and other post-discharge health care use constitute a significant proportion of the preterm infants care costs. A recent report from the Institute of Medicine estimates the annual preterm birth costs at US $26.2 billion with 16.9 billion associated with infant medical care. Adequate parental education can reduce the risk of readmission by ensuring that the parents seek medical attention appropriately, administer medications and other therapies correctly, and show confidence in the home management of non-acute medical problems.
Interventions to teach parents about the skills needed should result in parents being discharge prepared. However, discharge readiness is decided by both the parents and the clinical staff. Full-term infant studies indicate that, despite discharge teaching, some parents do not feel adequately prepared. Among preterm infants, this is a crucial aspect of neonatal care that has had only limited research. We are only aware of one group exploring this issue for the NICU patients for whom the skill level needed by parents is generally higher.
We sought to augment the published literature by first quantifying how prepared the discharge families felt on leaving the hospital. Then, we compared the family's self-perception with that of the nurse's regarding discharge preparedness. Finally, we wanted to determine which elements contribute the most to a family's discharge preparedness.
Abstract and Introduction
Abstract
Objective: (1) Quantify and compare the family's and the nurse's perception regarding the family's discharge preparedness. (2) Determine which elements contribute to a family's discharge preparedness.
Study Design: We studied the families of all the infants discharged from a neonatal intensive care unit after a minimum of a 2-week admission. The families rated their overall discharge preparedness with a 9-point Likert scale on the day of discharge. Independently, the discharging nurse evaluated the family's discharge preparedness. Families were considered discharge 'prepared' if they rated themselves and the nurse rated their technical and emotional preparedness as ≥7 on the Likert scale.
Result: We had 867 (58%) family–;nurse pairs who completed the survey. Most families (87%) were prepared for discharge as assessed by the concordant questionnaire (Likert scores of ≥7 by the parent and the nurse). In multivariate analysis, confidence in their child's health and maturity (odds ratios, OR = 2.5 95% confidence interval, CI (1.2, 5.3)), their readiness for their infants to come home (OR = 2.9 95% CI (1.0, 8.3)), and selecting a pediatrician (OR = 4.2 95% CI (1.6, 11.0)) were statistically significant.
Conclusion: Assistance with pediatrician selection and home preparation may improve the percentage of families prepared for discharge.
Introduction
Discharge preparation in the neonatal intensive care unit (NICU) is critically important. Even for families with healthy term infants, poor discharge preparation has been linked to problems at home and increased unscheduled health care use. Poor discharge planning has the potential for even worse outcomes for preterm infants because of their poor cues to needs and ongoing medical problems after hospital discharge, in particular, those with lung disease and others at the highest risk for rehospitalization.
Rehospitalization and other post-discharge health care use constitute a significant proportion of the preterm infants care costs. A recent report from the Institute of Medicine estimates the annual preterm birth costs at US $26.2 billion with 16.9 billion associated with infant medical care. Adequate parental education can reduce the risk of readmission by ensuring that the parents seek medical attention appropriately, administer medications and other therapies correctly, and show confidence in the home management of non-acute medical problems.
Interventions to teach parents about the skills needed should result in parents being discharge prepared. However, discharge readiness is decided by both the parents and the clinical staff. Full-term infant studies indicate that, despite discharge teaching, some parents do not feel adequately prepared. Among preterm infants, this is a crucial aspect of neonatal care that has had only limited research. We are only aware of one group exploring this issue for the NICU patients for whom the skill level needed by parents is generally higher.
We sought to augment the published literature by first quantifying how prepared the discharge families felt on leaving the hospital. Then, we compared the family's self-perception with that of the nurse's regarding discharge preparedness. Finally, we wanted to determine which elements contribute the most to a family's discharge preparedness.
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