A PROGRAM TO REDUCE DISCHARGE DELAYS IN A NEONATAL INTENSIVE-CARE UNIT

Our hypothesis was that a program designed to identify the causes of d ischarge delays would reduce the length of stay in our neonatal intens ive care unit. We reviewed every admission from January, 1994, to Dece mber, 1995. A discharge delay was defined as any delay not related to illness after the infant was cleared for release. Discharge delays wer e divided into the following categories: primary healthcare team, orga nizational, discharge planning, family, monitor related, and other. po tential discharge delays were identified daily according to establishe d criteria. Actual discharge delays were reviewed monthly at a staff m eeting attendees by representatives of a multidisciplinary team. We id entified 116 discharge delays, which accounted for 480 patient days. E ighty-three discharge delays accounted for 302 patient days in 1994, a nd 33 discharge delays for 178 patient days in 1995. Discharge delays ranged from 1 to 34 days, with an average of 4.1 days added per patien t. Infants with discharge delays had a case mix index of 9.32. The ave rage case mix index for the neonatal intensive care unit was 6.25 duri ng 1994 and 5.18 during 1995, an average of 5.71 for the review period . Forty-four percent of infants who Rad discharge delays had private i nsurance, 55% had Medicaid, and 1% had self-payment arrangements. Eigh ty-eight of 116 discharge delays were caused by circumstances beyond t he control of the primary care team. An additional 25 of 116 discharge delays were the result of our policy requiring 48 hours free of apnea -bradycardia alarms before discharge. Discharge delays for 1994 cost $ 226,298 ($749/day). For 1995, discharge delays cost $41,553 ($233/day) for a total cost of $262,431. Total savings in 1995 versus 1994 was $ 184,745 ($516/day). Despite the low birth weight and relatively severe illnesses of the infants, we believe that a focused team approach and monitoring for potential discharge delays can result in considerable reduction in hospital stay and cost.