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Earlier Discharge of Infants from Neonatal Intensive Care Units: A Pilot Program of Specialized Case Management and Home Care

Division of Neonatology, Jefferson Medical College, 700 College Bldg., 1025 Walnut St., Philadelphia, PA 19107

Renee B. Girifalco, RN

Eric Gibson, MD

Robert L. Stavis, MD, PhD

Jay S. Greenspan, MD

Alan R. Spitzer, MD

The Delaware Valley Child Health Alliance; The Department of pediatrics, Jefferson Medical College

A multidisciplinary approach using a neonatology independent physicians association, affiliated hospitals, a pediatric home care company, and a health maintenance organization was designed to promote earlier safe discharge of infants from intensive care. This pilot project involved 43 infants who received case management and early discharge home with home oxygen, monitoring, intravenous antibiotics, gavage feedings, phototherapy, or nutritional management for poor weight gain. A staff neonatologist remained the primary physician until the patient would have been discharged according to standard criteria. Two patients had unscheduled readmissions and all infants survived. This approach resulted in an estimated savings of 456 hospital days and $329,982; 89% of parents rated the care as good to excellent, and 83% were satisfied with the program and outcome. This study suggests that a prospectively designed program can be designed to promote safe earlier discharge of infants in intensive care.

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