Increasing Quality Outcomes and Patient Satisfaction Scores with Decreased Length of Stay Postpartum

INCREASING QUALITY OUTCOMES AND PATIENT SATISFACTION SCORES WITH DECREASED LENGTH OF STAY POSTPARTUM 1

Increasing Quality Outcomes and Patient Satisfaction Scores withDecreased Length of Stay Postpartum

Institution Affiliation

Over the years, extensive research has been conducted to establishthe nature of relationships between reduced lengths of stay ofpostpartum. Concerning patient satisfaction, the cost-effectivenessof the practice has been highlighted for the sole purpose ofestablishing the nature of patient satisfaction. To accomplish thistask, there is a need to employ a practical model exploration thatwill include the use of secondary data from various credible sources.Additionally, recent government reports have encouraged the healthinstitutions to provide the women with more choice about their care(Bowers &amp Cheyne, 2015).

The target population, in this case, will be the women underpostpartum care across various hospitals in the country. With theneed to identify the relationship between satisfaction scores amongthe patients and decreased the length of stay postpartum, this studywill sue data from past studies to develop conclusions. Using theactivity conceptual framework, the study highlights factors relatingto the patients’ attitudes towards issues relating to the changingtrends in the healthcare system (Dowswell et. al., 1997). Therefore,it identifies ways through which the satisfaction of patientscontinues to receive widespread across the board. One hundred andtwenty women from six districts in the Yorkshire region would formpart of the research process. In this case, the total number ofparticipants was seven hundred and twenty women in the postnatalperiod (Dowswell et. al., 1997).

The rationale for selecting the concept of quality of outcomes andpatient satisfaction score with decreased length of stay postpartumis based on the high need to provide a lasting solution to theproblems facing the women. Moreover, there is need to establish waysthrough the nursing profession, and other medical practitioners canbe integrated into the studies to provide the required level ofcompetencies. In this case, the selection process identified waysthrough which the current trends impacted on the overall outcomeswithin the healthcare sectors. Therefore, the topic was deemed asimportant since it had a direct relationship with mothers and infantswithin the society. Women were allowed to participate in the study ifonly they meet certain criteria. The women must have given birthwithin a four-week period in one of the maternity units that had beenincluded in the study. Secondly, the baby must be alive having beendelivered 37 weeks after gestation. Finally, the child must have beendischarged home together with the mother (Dowswell et. al., 1997).

The research process was based on obtaining data from variouscredible secondary sources. The primary objective of the study was todetermine the nature of relationships between the quality as well assatisfaction scores about decreased length of postpartum. Theresearch, therefore, focused on six specific districts in theYorkshire region and was tailored towards meeting the objectivesrelating to the reduced duration of stay following delivery (Dowswellet. al., 1997). The study aimed at establishing describing existingvariations within the healthcare system and further exploration ofassociations between various relevant variables. The variablesincluded care process variables, maternal psychology wellbeing, andconsumer satisfaction (Dowswell et. al., 1997).

The research focused on one hundred and twenty women that had beenrandomly selected. They represent six districts and the period of theinvestigations lasted for four weeks. The women were expected tocomplete postal survey questionnaires. The survey was to be conductedin the postnatal stages. The key variables that were to be analyzedin this case included issues relating to satisfaction, levels ofdepression and the maternity experience by the patients (Dowswell et.al., 1997).

There have been various challenges relating to the streamlining andcoordination of postpartum as well as the newborn education (Jones,1997). Additionally, there have been increased efforts to increaseconsumer satisfaction among the patients in the maternity serviceprovision. Concurrently, there has been increased demand from thecommunities for the lowering of costs as a means of maternity.Maternity units have therefore embarked on a series of changes aimedat facilitating improved quality of outcomes while also ensuring thatthe patients are provided with the best form of medical care in thematernity units (Bowers &amp Cheyne, 2015).

To determine the appropriate period of postnatal stay, variousfactors have to be taken into considerations (Reeveret. al., 1998). Such issues are varied along numerous conceptsand arguments. Some of the factors that determine the nature of timethat should be given to others include such as individual clinicalneeds and the maternal preferences preferred by respective patients.However, when comparing factors that are likely to influence theperiod taken during the postnatal period, it is important toestablish the fact that the length of postnatal hospital stay doesnot represent a substantial amount of the resources utilized (Jones,1997). As a result, medical practitioners, as well as the nurses,have embarked on ways through which the number of days spent at theclinic can be reduced considerably.

New hospital developments in the medical sectors are therefore likelyto benefit from financial assistance if only they implement thestringent rules to govern the nature of relationships inorganizations. However, there is limited information regarding theeffects of postnatal stay based on the number of days (Jones, 1997).This is more significant in case the period of rest is regarded to bebetween 2-3 days. Some of the factors that have been identified toinfluence the nature of outcomes include the level of depressionamong the patients as well as the patients’ satisfaction scores.Based on the numerous challenges experienced within the provision ofpostpartum, it is evident that various correctional strategies needto be implemented to facilitate the achievement of desirableoutcomes. As such, there is the need to provide education andtraining to the most affected persons within the population (Jones,1997). New mothers are the ones who are directly affected by suchoccurrences and as such, they need to be enlightened regarding theexpected outcomes and ways through which the quality outcomes andpatient satisfaction can be achieved (Bowers &amp Cheyne, 2015).

Written information can be used to reinforce the verbal means ofeducating the new mothers on the important aspects of life (Reeveret. al., 1998). This can be in the form of educationalbooklets that are issued to expectant women and new mothers to enablethem to understand the concept surrounding the length of staypostpartum. For some parents, research has indicated the belief thathaving more individual time with the nurses during the postpartumperiod equips them with the relevant capabilities to enable them tolearn the basics of caring for their young ones (Jones, 1997). Thequality improvement part of the postnatal care can be furtherenhanced through the issuance of written educational booklets and thecreation of individualized patient educational plans (Reeveret. al., 1998). Additionally, it can be achieved through theintegration of various forms of educational procedures during thehospital stay. This provides ample time for the new mothers to makeinquiries regarding ways through the quality of lives of theirnewborns can be enhanced.

Patient education is regarded as one of the most important conceptsfor all individuals seeking medical attention as well as those who donot. In most instances, the nurses at the postpartum are faced with adilemma in their areas of operations. Women are usually too anxiousto leave the hospital and proceed home whereas others wait for thecreation of a bed vacancy. These two factors make it necessary to thenurses in the postpartum units to offer education to their members.Therefore various factors such as duties to their patients, thedemands of the physicians as well as the desires of the familymembers all compete for the nurses’ attention. The registerednurses use their competencies to facilitate the education to thepatients. Moreover, such levels of expertise enable the nurses toidentify ways through which patients can learn about the essentialelements concerning the improving the quality outcomes and patientsatisfaction scores (Jones, 1997).

According to research, the number of women spending a large number oftheir postnatal days in the hospital has decreased massively (Bowers&amp Cheyne, 2015). The trend has significantly been witnessed inthe Western countries. Initially having an average of 14 daysstandard lying-in period in hospitals, the number of days spent bywomen in the hospital today stands at a low two to three days. Thistrend is witnessed in Australia, Canada, Sweden, United States andthe United Kingdom among other locations across the globe. However,one common question that has generated massive debate has been onwhether the number of days spent by mothers at the health facilitiesafter they conceive. Most of the arguments focus on the safety of thechildren as well as ways through the quality of life for both motherand child can be guaranteed.

Since the 1950s, the debate on the adverse ranges of outcomes thatare inherent in shorter stays in the hospital has attracted variedviews. The number of negative impacts that can be associated withshorter length of stay postpartum has continued to rise over theyears. Some of the downturns that have been identified include delaysthat might be witnessed in detecting and offering treatment to thechildren as well as maternal morbidity. Additionally, there have beenhigher cases of maternal depression and a substantial amount ofinfant and maternal readmissions. In the early medical journals, itwas established that the early discharge of patients with few staysafter the postpartum period were likely to culminate into an increasein the number of children developing severe hyperbilirubinemia.However, the credibility of such outcomes has been challenged sincethe studies were obtained from individual case series and as suchvery few instances were integrated into the studies. There was,therefore, no opportunity for an adequate group in the assessment ofthe effects of the early discharge. Other journals, later on,discussed the factors surrounding the early discharge of newborn as acontributing factor to the substantial growth in neonatalreadmissions.

However, this debate continued to drag on as most individuals haveforwarded their support for the shorter period spent with the youngones at the health facilities. They argue that there are no adverseconsequences for the mothers of the young ones in case they decide toleave the hospitals promptly after the birth of their children.Additionally, those advocating for shorter lengths of stay state thechanging trends whereby birth centers are being considered as a stepaway from health and towards the a more family-centered approach.However, there is a universal agreement concerning the disadvantagesin the postpartum period mirroring the benefits that can be obtainedfrom such programs.

Methods

A study referred to as “Patterns of maternity care” has beenconducted in the early 1990s to establish the aspects of servicedelivery in the maternity units (Dowswell et. al., 1997). Thevariables under study included the length of postnatal stay as wellas the costs involved and maternal outcomes in maternity services inall the six districts within Yorkshire regions. The choice of the sixareas took into consideration the diverse socio-demographic and thegeographical characteristics of the location (Dowswell et. al.,1997). In the final stages of the study, a survey questionnaire wasissued to the women involved in the study. The primary objective ofsuch a study was to establish the opinions of the patients regardingconsumer satisfaction and psychological outcomes (Bowers &ampCheyne, 2015).

The survey questionnaires were posted to the women who were betweenfour and eight weeks postpartum. For those who failed to fill theirquestionnaires and submit them within two weeks, a reminderquestionnaire was posted to them. It is important to note that thequestionnaires were tailored according to the Office of PopulationCensus and Surveys (OPCS) survey manual (Dowswell et. al., 1997). Init were questions relating to about the individual experiences of thewomen. The Edinburg depression scale (EDS) was used to establish thestandard measure of psychological wellbeing. From the resultsobtained, the response rate was at 71% with the answer rates rangingfrom 6% and 79%. In the analysis, the districts were coded from A toF (Dowswell et. al., 1997). various statistical analysis wereutilized in the research, and they included analysis of variance aswell as multiple regressions. Such statistical analysis was used forthe sole purpose of establishing the nature of relations between theputative factors involved in the study (Britton,1998).

Results

All the one hundred and twenty women were issued with the surveyquestionnaires. With six districts involved in the study, the totalnumber of individuals participating in the study was seven hundredand twenty respondents. The results were divided into varioussegments as discussed below.

Comparison of length of stay and depression

There was minimal statistical significance when comparing the lengthof stay between the districts (Dowswell et. al., 1997). This process,however, did not take into consideration any the mode of delivery ofthe women. However, it was established that most women had normaldeliveries but had substantial statistical differences in the periodspent in the hospital by each of the patients depending on thedistrict of their delivery. The figure below shows the overall meanstay for women in all the areas. From the numbers given, the averagefor normal deliveries across Yorkshire region was 2.58 days (Dowswellet. al., 1997).

District Mean Length of Stay

A 2.01

B 2.92

C 3.03

D 2.65

E 2.16

F 2.67

Descriptive Statistics

Column1

Mean

2.573333

Standard Error

0.166547

Median

2.66

Mode

#N/A

Standard Deviation

0.407954

Sample Variance

0.166427

Kurtosis

-1.49997

Skewness

-0.49107

Range

1.02

Minimum

2.01

Maximum

3.03

Sum

15.44

Count

6

Additionally, the existing variations make it essential to establishwhether differences in services affect the length of days which themothers should spend in the hospital. It is imperative to determinewhether the days can be shortened without affecting the quality ofoutcomes and patient satisfaction. The study discovered that onepossible cause of variations in the study related to the emotionalwellbeing (Dowswell et. al., 1997). However, there are no significantdifferences in the mean depressions among the women experiencingnormal deliveries within the six districts. In respect to whether thewomen though which of the options of stay (too long, too short, aboutright) was appropriate, there was no significant differences amongthe districts. Table 2 shows the length of stay based on the type ofdelivery and the corresponding standard deviation (Dowswell et. al.,1997).

Type of Delivery Mean

Normal 2.58

Caesarean 5.94

Forceps 3.63

Descriptive Statistics

Column1

Mean

4.05

Standard Error

0.992421282

Median

3.63

Mode

#N/A

Standard Deviation

1.718924082

Sample Variance

2.9547

Kurtosis

#DIV/0!

Skewness

1.033881716

Range

3.36

Minimum

2.58

Maximum

5.94

Sum

12.15

Count

3

According to the study, various factors were likely to influence theperiod of stay in a hospital after delivery. Such factors alsodetermine whether the women suffered any form of depression as wellas the level of satisfaction with their stay at the healthcarefacilities. They included obstetric factors that defined whether thewoman had a healthy delivery. This depended on the case mix as wellas the variables that form the care process. Additionally, socialfactors such as deprivation which can be associated with depressionand anxiety. The research, therefore, established that despitevariations in the number of days of stay postpartum, the levels ofdepression and patient satisfaction did not experience anysubstantial changes (Weiss &amp Lokken, 2009).

Length of Stay and Maternity Experience

According to this comparison analysis, many stays were affected basedon the nature of pregnancies and the universal experiences. Table 2above can be used to analyze the nature of relationships betweennormal deliveries and other forms of delivery. The study establishedthat women who underwent caesarean section had higher rates ofdepression (8.42) in comparison to those with normal deliveries(6.84) and forceps deliveries (6.62) (Dowswell et. al., 1997).

Consumer Satisfaction and Depression

Psychological factors among the women played a significant role inestablishing whether the women perceived the days of stay asappropriate (Britton, 1998). For thisstudy, more than 85% of the women declared their satisfaction withthe length of stay at the healthcare facilities. Another factor thathad a substantive influence on the women was the district norms. It,therefore, influenced the period the women considered to be the mostappropriate period of stay. However, the length of stay had a directrelationship with the level of consumer satisfaction. By using thethree stages of measurements, the women who believed that they hadstayed for “too long” had a mean of 3.1 days. Those that felt“about right” had a mean of 2.6 days of stay while those whobelieved that their stay had been “too short” had an average stayof 1.9 days (Dowswell et. al., 1997).

The study further investigated the women who had normal deliverieswith regards to the relationship between satisfaction with the lengthof stay and maternal depression. In this respect, various factorsthat influenced the relationship between the two variables wereestablished. Through the use of a regression analysis, multiplevariables such as housing tenure, pregnancy risk and the level ofconsumer satisfaction were all taken into account. The rate ofmaternal satisfaction about the length of stay was significant.Additionally, mothers who felt that the duration of stay was shortrecorded the highest readings (2.75) in on the Edinburgh depressionscale (EDS). Women who resided in the council houses had higherreadings on the EDS in comparison to those who occupied their houses(1.6) (Dowswell et. al., 1997).

Conclusions

Mothers who are discharged after a few days can spend more time withthe family and sleep in the comfort of their homes (Britton,1998). Additionally, they are not exposed to interruptionsthat are associated with the daily hospital routines. The mother andthe infant are also safe as there is a substantial decrease in theirexposure of the infant to nosocomial infections (Weiss&amp Lokken, 2009). The home environment also provides themother with the opportunity to provide a healthy environment for theinfant since they operate from the comfort of their homes.

References

Bowers, J., &amp Cheyne, H. (2015). Reducingthe length of postnatal hospital stay: Implications for cost andquality of care. BMC Health Services Research BMC Health Serv Res,16(1).

Britton, J. R. (1998). Postpartum EarlyHospital Discharge and Follow-up Practices in Canada and the UnitedStates. Birth, 25(3), 161-169.

Discharge Versus Traditional Length of Stay.Southern Medical Journal, 91(2), 138-143.

Jones, P. M. (1997). Patient satisfaction withhome care after early postpartum hospital discharge. Home CareProvider, 2(5), 235-241.

Reever, M. M., Lyon, D. S., Mokhtarian, P. L.,&amp Ahmed, F. (1998). Early Postpartum Discharge Versus TraditionalLength of Stay. Southern Medical Journal, 91(2), 138-143.

Weiss, M. E., &amp Lokken, L. (2009).Predictors and Outcomes of Postpartum Mothers` Perceptions ofReadiness for Discharge after Birth. Journal of Obstetric, Gynecologic

Dowswell, T., Piercy, J., Hirst, J., Hewison,J., &amp Lilford, R. (1997). For debate Short postnatalhospital stay: implications for women and service providers. Journalof Public Health Medicine Vol. 19, No. 2, pp. 132-136. Retrievedfrom: http://jpubhealth.oxfordjournals.org/content/19/2/132.full.pdf