Early Discharge: In the End, It Is Judgment

Abstract

"Early to bed and early to rise, Makes a man healthy, wealthy and wise," proclaimed Benjamin Franklin.¹ Early warning, early detection, early periodic screening, diagnosis and treatment, early dismissal, early filing—the litany goes on. Indeed, early has always connoted an astuteness, a positive gain of some sort. Yet recent newspaper and magazine articles have challenged that adage by calling attention to observations of untoward consequences resulting from early discharge of newborns and their mothers from the hospital (Sugg DK. Giving moms, newborns more time in the hospital. Baltimore Sun. April 4, 1995:1; Cost cuts shrink hospital stays for children. The New York Times. May 6, 1995; Nordheimer J. Broad coalition fights insurer limits on hospital maternity stays. The New York Times. June 6, 1995; Lord M. Check in, deliver, go home. us News and World Report. December 5, 1994:98-100). In anticipation of the need to address those observations, the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration has taken the lead in assessing and tracking this issue nationally. This article describes the MCHB-supported investigations related to early discharge, including findings and recommending next steps.

BACKGROUND

The MCHB focus on length of hospital stay for newborns and their mothers began with an observation regarding rehospitalization of recently discharged newborns. Wallace et al of the San Diego County, CA, 1985 Cohort Infant Mortality Study Group,² in work sponsored by the MCHB, reported that infants who died in the postneonatal period were significantly more likely to have been rehospitalized (excluding the hospitalization during which death occurred) than infants in the control group (surviving infants matched for plurality and month of birth).