English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

Background. Improved survival and shorter lengths of stay for preterm infants, together with poorly organised discharge planning in some neonatal units leaves many parents ill-prepared to take their babies home, with increased use of out of hours services. Despite the importance accorded to family-oriented neonatal care by the Department of Health and NICE, few neonatal units offer structured, family-oriented discharge planning.   Objectives. To implement a parent-oriented discharge planning approach (Train-to-Home) for preterm infants and investigate the effects on parental self-efficacy scores, infants’ length of stay (LOS) and use of healthcare resources in the 8 weeks after discharge. Design. A before and after study, investigating the effects of the Train-to-Home during two 11 month periods, immediately before and after its implementation.Setting. Four Local Neonatal Units in Southwest England.Participants. Infants without major anomalies born at 27-33 weeks gestation admitted to the participating units, and their parents.Train-to-Home Intervention. A parent-oriented package which incorporated approaches to improving parents’ involvement in and understanding of their baby’s needs. It comprised a train graphic and supporting care pathways to facilitate parents’ understanding of their baby’s progress through the neonatal unit, combined with improved estimation, soon after hospital admission, of the baby’s likely discharge date.  Main outcome measures. Perceived Maternal (and Paternal) Parenting Self-efficacy (PMPS-E) scores before and after implementing the Train-to-Home together with infant  LOS and healthcare utilisation after discharge.Results. Parents reported that the Train-to-Home improved their understanding of their baby’s progress, and their preparedness for discharge.  There was no significant change in PMPS-E scores after implementation of the Train-to-Home, but the number of visits to Emergency Departments (ED) fell from 31 to 20 (p<0.05), with a significant reduction in associated healthcare costs (£3400 to £2200; p< 0.05) after hospital discharge.  There was no reduction in LOS, but in both phases of the study more than 50% of infants went home more than 3 weeks before their EDD. Many nurses felt that the estimated discharge dates were over optimistic, despite being based upon recent local data, and accurately predicting discharge dates for almost 75% of babies in the study.Conclusions. In both phases of the study the very early discharge of most babies made further shortening of LOS very difficult to achieve. Despite the lack of measurable effect on the parental self-efficacy scores, the parents reported that their understanding and confidence in caring for their infants were improved by the Train-to-Home, and the reduction in ED attendance and associated costs supports this assessment.  The present study was limited by the tight time constraints for implementation, limited cascading of staff training, and lack of staff confidence in the estimated dates of discharge. Future work. Provision of the Train-to-Home as a web-based system allowing individual neonatal units and parents to access and use the materials may allow more effective implementation in the future.Study Registration. Not applicableFunding details.Funded by a grant (11/1015/09) from the NIHR Health Services and Delivery Research Programme

health services and delivery research

Preparing for Home: a before-and-after study to investigate the effects of a neonatal discharge package aimed at increasing parental knowledge, understanding and confidence in caring for their preterm infant before and after discharge from hospital