Table 6 Summary of intervention studies to strengthen discharge preparation

Arad (2007) [14]

Israel

To assess the maternal recall of the neonatal discharge letter instructions with and without nurse and mother signing the document in addition to the physician signature

Before and after

Mothers of infants born when nurse & mother signatures required (n = 109

Mothers of infants born when only physician signature required (n = 110)

Use of a neonatal discharge letter with instructions, changed to require nurse and mother signatures in addition to physician who examined the baby, to improve maternal recall of information delivered in the letter

At discharge

Whether discharge letter was understood; Staff openness for questions at discharge; Maternal recall of discharge instructions; Maternal satisfaction with dicharge procedure

Dag 2013 [71]

Turkey

To evaluate postpartum discharge readiness in women who had vaginal birth

Evaluation (cross-sectional survey)

Women who had normal vaginal delivery (n = 110)

No formal intervention in the study; women’s discharge readiness was assessed based on the routine care and education given at the time of discharge

At discharge

Breastfeeding rate at 1 month; readmmission or consultation rate in 1st month; rate of missing first exam or screening tests at 8 days; and parents satsfaction with care

Fleischmann (2015) [29]

USA

To enhance the discharge experience of the postpartum woman

Quality improvement (Six Sigma workout)

Not stated

Innovative program to enhance the discharge experience of postpartum women including: conducting sensing sessions with patients, adding additional emergency information to discharge instructions, querying other large women’s hospitals, teleconferencing with a top decile hospital, adding questions related to Help at Home video to the Get Well Network interactive woman education system, adding a Discharge Pathway to the Get Well Network, and performing a research study on discharge readiness

Timing not stated

Hospital Consumer Assessment of Hospital Providers and Systems (HCAHPS) discharge domain question scores

Kabakian-Khasholian (2007) [64]

Lebanon

To evaluate the impact of providing women with written educational material on their satisfaction with care, and use of health services postpartum

RCT

Women having a live birth

Intervention (n = 187)

Control (n = 191)

Providing women with written educational booklet that addressed health problems, breastfeeding, contraception, postpartum check-up, father’s role and women’s weight problems after pregnancy to improve satisfaction with care, and use of health services postpartum

At discharge

Postpartum visit to a health professional after discharge and before follow-up interview

Satisfaction with maternity care received during pregnancy, childbirth and postpartum

Meringer (2015) [28]

USA

To improve patient perception of readiness for discharge, by modifying delivery of care

Quality improvement (post- implementation survey)

Mothers and babies

(sample size not stated)

Blue discharge folder to be initiated upon admission and serve as a living document to record education and follow the woman throughout her stay. It serves as a reference for the interprofessional team as well as a continuous resource for home

On admission

Maternal readiness for discharge.

Matozinhos (2011) [72]

Brazil

To evaluate content and activities to be included in discharge orientaiton

Descriptive

(pre and post test)

Postpartum women (n = 73) and and accompanying person (19) who had given birth in the previous 25 h for vaginal birth or 48 h for a caesarean section located in a maternity ward of a public health institution.

A discharge orientation was provided through a group education session, using three different group dynamic activitie. An individual and individual post-test were applied.

Perceptions of maternal self-care, breastfeeding and care of the newborn

Salvador (2020) [56]

Canada

To describe the MPCH program model of care, maternal-newborn low-risk criteria and present the preliminary evaluation results of the program

Evaluation (cross- sectional survey)

Women who gave birth between Dec 2018-Dec 2019 and received care from the MPCH Program (n = 100)

Monfort Postnatal Care at Home Program (MPCHP) is an innovative alternative to the traditional hospital postnatal model which safely shifts early postnatal care for low-risk dyads from hospital to home

6-24 h after a vaginal birth / 24-48 h after caesarean birth

Postpartum hospital length of stay; Parental support required following hospital discharge; Breastfeeding at 6 weeks; Maternal satisfaction with MPCH programme

Türkmen (2017) [70]

Turkey

To investigate status of discharge readiness after education

Evaluation (cross-sectional survey)

Women who had normal vaginal delivery:

received training (n = 99)

no training (n = 24)

Education session implemented by health care provider before discharge

At discharge

Maternal readiness for discharge

Wilson (2016) [69]

USA

To evaluate the effectiveness of a designated nurse providing discharge education to increase the postpartum women’s perception of readiness for discharge

Non-randomised evaluation

Postpartum women who gave birth to a healthy term newborn with no perinatal complications

Intervention (n = 30)

Control (n = 30)

A designated nurse providing discharge education to increase the postpartum women’s perception of readiness for discharge

Focused on maternal perception of readiness but it is a discharge preparation intervention

Timing not stated

Discharge preparedness (personal status knowledge, coping ability, expected support)

Altuntug (2013) [73]

Turkey

To assess effect of education on discharge readiness, postpartum complaints and postpartum quality of life

Non-randomised evaluation

Pregnant women 32–36 weeks

Intervention (n = 40)

Control (n = 40)

Preparation

Educational progam for pregnant women comprising 3 sessions: 1) at 32–36 weeks readiness for labour, birth and postpartum issues; 2) before discharge newborn care and breastfeeding; 3) 4–6 weeks post-birth education about self-efficacy and quality of life after childbirth

32–36 weeks of pregnancy; before discharge; 4–6 weeks after childbirth

Discharge preparedness and quality fo life

Ingram (2016) [25]

England

To investigate whether introducing the parent-centred neonatal discharge package (Train-to-Home) increased parental confidence in caring for their preterm infant (self-efficacy), reduced infants’ length of hospital stay and reduced healthcare resource use after discharge

Before and after

Infants without major anomalies born at 27–33 weeks’ gestation

and their parents (n = 245 families)

Parent-centred neonatal discharge package (Train-to-Home) to increase parental involvement and understanding of their preterm baby’s needs, comprising a train graphic and supporting care pathways to facilitate parent’s understanding of their baby’s progress and physiological maturation, combined with improved estimation of likely discharge date

Intervention is used for discharge preparation but part of it includes criteria for discharge readiness

On admission

Infant attendance at emergency department;

Cost of emergency department attendance; Infant length of stay; Number of re-admissions or outpatient appointments before and after implementation; Perceived parental self-confidence in caring for infant

Moradi (2018) [65]

Iran

To determine the effect of an empowerment program on maternal discharge preparation and infants’ length of hospital stay

RCT

Mothers of premature infants in NICU

Intervention (n = 33)

Control (n = 32)

Maternal empowerment program initiated at admission to NICU until neonatal discharge and even after discharge. Family-oriented nursing intervention

On admission, during stay until discharge

Women’s satisfaction with care;

Women’s discharge preparedness; Newborn health; Length of hospital stay

Shieh (2010) [68]

Taiwan

To evaluate the effectiveness of structured discharge education on maternal confidence and knowledge and the growth of premature newborn

RCT

Mothers with premature babies with no congenital abnormalities

Intervention (n = 29)

Control (n = 30)

Structured discharge education for maternal confidence and knowledge and the growth of premature newborns using a 15-page brochure of caring for premature infants. Brochure contents included the explanation of follow-up examination at clinics, newborn screening, management of emergent situations, feeding, temperature measurement, bathing, oral hygiene and eye care, stool and urination, medication and vaccination. Mothers asked to demonstrate the skill of care individually, after introduction of the brochure

Timing not stated

Maternal confidence; Maternal caring knowledge;

Infant growth change (height, weight)

Wangruangsatid (2012) [74]

Thailand

Transitional care programme for mothers of preterm babies

RCT

Women with preterm infants

Intervention (n=)

Control (n=

Transitional care programme including 1.5–2 h classroom teaching session (with an educational video and a question and answer session) for mothers four days prior to infant’s discharge

Newborn morbidity; Newborn growth (weight, length, head circumference); Mother’s transition score (based on perceived knowledge and care giving skills and acceptance of being mother to a premature infant); Length of hospital stay