As a former hospital administrator, I’ve found it interesting to watch how hospitals have responded to pressure by Medicare and insurance companies to discharge patients quickly.
Many surgeries that used to require a short hospitalization to make sure that the patient was doing well post-operatively are now done on an outpatient basis. Of course, lots of outpatient surgeries aren’t even done at the hospital, in favor of more convenient ambulatory surgery centers.
I’ve sometimes joked that hospitals are in such a rush to get people out the door, the next step may be doing procedures in the parking lot!
We’ve reviewed many cases where financially-driven hospital discharges have led to terrible complications, outcomes, and even deaths of patients of all ages.
The areas of labor and delivery and post-natal care, though, haven’t been as affected by this trend as much as other types of care have.
In fact, there’s a growing body of medical literature that advocates against premature discharge of newborns from the hospital.
What’s a neonatal intensive care unit (NICU)?
Premature babies and other babies born with serious health problems are normally sent directly to a neonatal intensive care unit (NICU). By the way, not every hospital has an adequate NICU, so we believe this is an important consideration that expecting moms and dads should keep in mind when selecting a hospital for the big event.
Furthermore, not all NICUs are the same. The American Academy of Pediatrics defines criteria for hospital NICUs, which are split into four levels:
• Level I NICU: This is essentially the normal nursery care that most hospitals offer.
• Level II NICU: This is intensive care for babies that are born premature or with an illness.
A premature birth is defined as a delivery before the 37th week of pregnancy. Stated another way, pregnancy is defined as 40 weeks of gestation, but is considered normal when delivery occurs between weeks 40 and 42.
• Level III NICU: This level is more comprehensive intensive care for babies born with more serious illnesses.
• Level IV NICU: This is the highest level of NICU care, where hospitals have capabilities including major surgery for repair of congenital heart and pulmonary conditions and support by extracorporeal membrane oxygenation (ECMO) for serious medical conditions.
We’ve witnessed all kinds of reasons a newborn may get sent to a NICU, including congenital cardiac or respiratory issues, a traumatic delivery or hypoxic-ischemic brain injury, prematurity, infection or sepsis, hypoglycemia (usually when a mom has gestational diabetes), and maternal chorioamnionitis (infection of the placenta or umbilical cord).
The risk of premature discharge in normal deliveries
It’s easy to see how sending a premature or ill baby home too early could be life-threatening. What’s more surprising, though, is that premature discharge of healthy newborns also poses some significant risks.
One study found that healthy newborns discharged within the first 30 hours after birth have:
• An increased risk of dying within 28 days of birth.
• An increased risk of death during the first year of life.
• An increased risk of death from heart-related problems within the first year of life.
• An increased risk of an infection -related death within the first year of life.
Another peer-reviewed medical study found that discharging a newborn from the hospital any time less than 48 hours after birth poses some significant risks, including:
• A higher rate of readmission to the hospital for any illness.
• A higher rate of readmission because of hyperbilirubinemia.
Most people call hyperbilirubinemia jaundice, which can be recognized by a yellowish tint to the baby’s eyes and skin. About 60% of full-term babies develop jaundice. There is a 20% higher rate when there is a premature delivery. Hyperbilirubinemia is a condition where there’s too much of a substance called bilirubin in the blood. Bilirubin is a byproduct of the breakdown of red blood cells. Many babies aren’t quite ready to dispose of the excess bilirubin.
In cases of severe jaundice that’s not properly treated, the baby can develop brain damage called kernicterus.
• A higher rate of readmission because of infection or sepsis.
The authors of the second study found that premature newborns, those with a low birth weight (less than 2,500 grams or 5.5 pounds), and those who develop jaundice in the nursery have a particularly high risk of hospital readmission.
What can you do?
As a new parent, take some deep breaths and don’t be in a rush to get home. As a father of four, I know that hospital accommodations aren’t that great and there’s always a natural eagerness to get out of the hospital, settle down home, and introduce the new baby to family and friends.
Being patient with healthcare providers allows them to monitor and observe your baby for potential problems that are more easily addressed during their initial hospitalization.
If your obstetrician or the nursing staff seem to be in a hurry to send you and the baby home before 38 hours after birth, asked for a good explanation why and make sure you’re comfortable with the plan.
If you have experienced a serious injury because of premature discharge from the hospital, then contact a top-rated skilled Houston, Texas medical malpractice lawyer for help in evaluating your potential case.
