A Novel Approach to Reduce Non-Emergent Visits through a Mentored Postnatal Education Program

Saturday, 7 November 2015

Susan A. Hoffman, BSN, BA, RNC-MNN
Department of Nursing--Maternity, WellSpan Health, Tender Care Pregnancy Centers, Gettysburg, PA, USA
Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond, VA, USA
Barbara L. Buchko, DNP, MS, BSN, RNC-MNN
Department of Nursing, WellSpan Health, York, PA, USA

Purpose:  Anecdotal  information from nurses at two local hospitals suggested that mothers seemed to be accessing emergency services unnecessarily for their newborns after discharge from the hospital also.  The purpose of this project was threefold.  The first step was to identify the most common non-emergent reasons that mothers bring their newborns (age birth to 9 months) to a local emergency department.  Given these common reasons, two face-to-face postpartum classes were developed to provide educational information that would address the commonly occurring health issues (step two). The classes were offered at a local non-profit pregnancy help center at no charge. The third aspect of this project was to develop the leadership skills needed to work with the interdisciplinary team enacting the project as one way to bridge the local hospital and a community-based to improve maternal-child care and reduce unnecessary costs. Understanding the principle reasons that motivate mothers to bring newborns for emergent care has allowed us to “work as one to improve health through exceptional care.”  

Methods: This project was conducted in a 76-bed Pathway to Excellence community hospital in northeastern United States; an organization that is but one member of a larger health care system.  A hospital chart audit revealed that 378 newborns from age birth to 9 months were seen in the emergency department for diagnoses deemed to be non-emergent during calendar year 2013. The most common reasons the newborns were brought for health care to the emergency room were fever, vomiting, upper respiratory infections, bronchiolitis, and suspected otitis media. As a result of this finding, two postpartum face-to-face classes were developed for new mothers by a team of maternity nurses, laypersons and a local pediatrician using evidence based information. These educational sessions were offered by trained laypersons and adult learning principles were applied while using multi-modal learning materials.  The effects of the program were assessed using a pre-/post-test design through the use of a knowledge questionnaire.

Results:  Demographic data was collected to appreciate general characteristics about the participants at baseline.  The effects of the intervention were assessed by determining the change in mothers’ knowledge following their participation in the educational classes. Additionally, the mothers’ perceived ability to determine the urgency of health issues and know what steps to take were assessed .

Conclusion: By identifying common non-emergent reasons mothers access emergency services, postpartum education can be provided through one on one mentoring programs to improve newborn health and reduce unnecessary medical costs.  As my leadership skills have developed, I am more able to facilitate the collaboration of hospital and community-based organizations to ‘work as one’ and provide exceptional evidence-based health care, and thus improve the maternal-child health outcomes in our community.