ABSTRACT
BACKGROUND: Short-stay obstetric stays have been the recent focus of many social and medical debates. We did a retrospective study of a large community teaching hospital's experience in making a safe transition to short-stay obstetrics. METHODS: Over a 10-month period, a multidisciplinary committee developed an intrapartum and postpartum education program to allow short hospital stays after uncomplicated vaginal deliveries. Computerized data were then retrieved on all uncomplicated spontaneous vaginal deliveries (DRG 373) from January 1994 to March 1995. RESULTS: During the study period, 554 women were discharged on the first postpartum day, resulting in three maternal readmissions and nine pediatric readmissions (combined readmission rate of 2.2%). This low readmission rate compared favorably with our experience with 2,563 uncomplicated vaginal deliveries from January 1991 to December 1993, immediately before the institution of the short-stay obstetrics program (combined readmission rate of 3.9%). The average hospital cost for a 1-day stay was $1,714 compared with $2,477 for a 2- to 3-day stay, representing a saving of only 31%. CONCLUSIONS: Early obstetric discharges after an uncomplicated spontaneous vaginal delivery can be safe and effective with appropriate patient selection and support.
Subject(s)
Health Plan Implementation/statistics & numerical data , Infant, Newborn, Diseases/epidemiology , Length of Stay/statistics & numerical data , Patient Discharge/statistics & numerical data , Patient Readmission/statistics & numerical data , Puerperal Disorders/epidemiology , Cost Savings , Female , Health Plan Implementation/economics , Humans , Infant, Newborn , Infant, Newborn, Diseases/economics , Length of Stay/economics , Male , Patient Discharge/economics , Patient Readmission/economics , Puerperal Disorders/economics , Virginia/epidemiologyABSTRACT
A small subset (n = 18) of highly discriminatory tests was derived from the feature frequency of 50 tests used in the study of 167 predominantly clinical Aeromonas strains. Seven of these eighteen tests were used to construct a flexible, dichotomous key, Aerokey II, for identifying clinical aerontonads: esculin hydrolysis, gas from glucose, acid from arabinose, indole production, acid from sucrose, Voges-Proskauer reaction, and resistance to cephalothin (30 micrograms). This schema was initially evaluated in a single-blind trial of 60 well-characterized clinical Aeromonas hydrophila (n = 21), A. caviae (n = 19), and A. veronii bv. sobria (n = 20) strains from an independent laboratory. Of the 60 strains tested, 58 (97%) were accurately identified to the species level. Aerokey II was further evaluated with 18 additional American Type Culture Collection and reference strains representing the more recently proposed taxa A. veronii bv. veronii, A. schubertii, A. jandaei, and A. trota and accurately identified all of these strains.
