Postpartum triage, services provided, and length of stay for infants born at 35 weeks gestation.

OBJECTIVES: The aim of this article is to (1) compare the care setting to which 35-week infants are initially triaged postpartum to the level of services subsequently provided; and (2) identify factors known at delivery or immediately postpartum associated with services received and length of stay during the birth hospitalization. STUDY DESIGN: In this multicenter retrospective study of 35-week infants born between 2007 and 2008, service capabilities of the initial postpartum care setting were categorized as level 1 or neonatal intensive care unit (NICU) using American Academy of Pediatrics definitions. Subsequent services actually provided were categorized as routine care, level 1, or >level 1. RESULTS: Over half of 431 studied infants were sent to a level 1 nursery postpartum. Of these, over 90% ultimately received routine care or level 1 services. Of 200 infants triaged to a NICU, the majority received only routine care or level 1 services. The great majority of infants requiring > level 1 services were identified promptly postpartum. Initial triage to the NICU was associated with significantly (p < 0.05) increased length of stay despite provision of similar services. CONCLUSIONS: This study suggests a need for improved triage of 35-week infants and provides tools for this purpose. Validation of the models presented here is warranted.

Postpartum/newborn patients: who are they and do they all need the same amount of nursing care?

AIM: To obtain a quantitative description of mother-newborn presentations and to identify their nursing care requirements while in hospital. BACKGROUND: Recommendations on minimum staffing levels are broad based with implications that all new mothers and newborns are normal without complications. However, in a large tertiary centre, mother-newborn dyads do present with complications, suggesting variation in nursing care requirements. METHOD: Two studies were conducted: (1) a cross-sectional retrospective, descriptive study; and (2) a convenience sampling survey professional nurses' expert opinions. RESULTS: A sample of 1224 mother and/or newborn presentations was retrospectively classified. Almost half of the patient presentations were classified as having complications. Nursing care ratios required for postpartum ranged from 1:1 to 9:1. CONCLUSION: An objective classification system was obtained from nursing experts in caring for mother and newborn with variable needs, in a hospitalized setting. IMPLICATIONS FOR NURSING MANAGEMENT: This comprehensive classification system can be used to objectively align nursing resources to mother/newborn care needs.