To reduce the length of hospital stay for premature infants by 30 percent.

• Length of hospital stay
• Readmission rate after discharge
• Monetary cost savings
• Feedback from nurses and parents

• Implemented new discharge guidelines for premature babies
• Standardized early discharge planning (i.e., starts from NICU)
• Provided discharge education to main caregiver, other than the mother
• Developed printed material for parents
• Developed an early discharge checklist
• Changed nursing role from patient caregiver to coordinator

After implementing the changes, we have over-achieved the target of 19.8 percent in reducing the length of stay for premature babies. We also achieved intangible results:

• The parents of these babies accepted the concept and participated actively in the discharge process.
• The nurses disliked the change of role initially. But in the later stages, they valued parents’ contribution to infant care while achieving job satisfaction through playing the roles of a teacher, facilitator-cum-expert.

We sustained the implementation by doing the following:

• Make the process as simple as possible; this helps to make it a win-win situation for both the parents and staff
• Formally announced the new discharge program to all doctors and nurses
• Conduct training on coordination of discharge planning
• Give the opportunity for staff to give feedback

Lessons Learned:

• Early discharge program is clearly achievable for a large number of premature babies
• Our experience shows that it is possible to motivate and involve parents in the care of a premature baby in the hospital with early discharge home
• Communication is the key
• We proposed our system as a model program that can decrease costs without compromising quality of care

Cheong Chiu Peng , Nurse Clinician
Singapore General Hospital
cheong.chiu.peng@sgh.com.sg

[Posterboard presentation from IHI's December 2007 National Forum]