BOOMERANG BABIES - EMERGENCY DEPARTMENT UTILIZATION BY EARLY DISCHARGE NEONATES

Introduction: Since 1987 the average length of stay for infants follow ing hospital delivery has decreased 1.8 days. This study was undertake n to evaluate the null hypothesis that early discharge of newborns fro m nurseries does not result in increased emergency department (ED) uti lization during the first 10 days of life. Site: Thirty community EDs, one university ED. Methods: Retrospective review of ED visits of pati ents two to 10 days of age from 1989 to 1995. The absolute number of E D neonatal visits (NVs) was compared to the total number of ED visits for each year and the ratio of NV/10,000 ED visits determined. The dis position and diagnosis of each patient was noted, and the number and p ercent of infants admitted to the hospital calculated. Results: A tota l of 3.1 million ED visits were reviewed, and 2094 NVs identified. The ratio of NV/10,000 ED visits increased from 4.3 in 1989 to 7.8 in 199 5 (P < 0.001), while the average length of stay for deliveries decreas ed from 2.79 days to 1.85 days. The mean percent of patients admitted from the ED was 10.3% and showed no statistically significant changes over the study period. The majority of visits were for minor medical o r educational problems. Conclusion: The null hypothesis is rejected. E arly discharge of neonates does result in increased ED utilization. No increase in admission rates for these infants was documented, indicat ing that patient severity did not increase with ED utilization. There is a need for improved predischarge education and greater access for e pisodic ambulatory complaints.