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Obstetrics & Gynecology 1994;84:832-838
© 1994 by The American College of Obstetricians and Gynecologists
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A Randomized Trial of Early Hospital Discharge and Home Follow-Up of Women Having Cesarean Birth

DOROTHY BROOTEN, PhD, RN, MARIANNE RONCOLI, PhD, RN, STEVEN FINKLER, PhD, CPA, LAUREN ARNOLD, PhD, RN, ARNOLD COHEN, MD and MICHAEL MENNUTI, MD

From the Center for Low Birthweight Research, University of Pennsylvania, School of Nursing, and the Department of Obstetrics and Gynecology, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania

Abstract

Objective: To determine the safety, efficacy, and cost savings of early hospital discharge of women delivered by unplanned cesarean delivery.

Methods: Using randomized assignment, 61 postpartum women were discharged from the hospital at the usual time, and 61 were discharged early and had nurse specialist home follow-up care. The latter group received comprehensive discharge planning, instruction, counseling, home visits, and daily on-call availability from the nurse specialists. Both groups were followed from delivery to 8 weeks postpartum.

Results: Women who were discharged early and received transitional home care services by clinical nurse specialists were sent home a mean of 30.3 hours earlier than the control group (P<.001). They had significantly greater satisfaction with care, more of their infants had timely immunizations at the end of follow-up, and they had a 29% reduction in health care charges compared to the control group receiving routine care. Although there were no statistically significant differences in maternal and infant rehospitalizations and acutecare visits, there were more maternal rehospitalizations in the control group than in the nurse specialist-followed group (three versus zero). No statistically significant differences were found between the groups in the outcomes of maternal affect and overall functional status.

Conclusion: Early hospital discharge of women after unplanned cesarean birth, using the model of nurse specialist transitional home care, is safe, feasible, and cost-effective.




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