To give a child a healthy start in life, Griffin Hospital in Derby, Conn., offers new mothers and babies a free return visit and checkup within 72 hours of discharge. About 94% of mothers choose to return with their newborns, and nurses have identified problems in one of three of the mothers and babies assessed.
For its "Healthy Beginnings" return visit program, 160-bed Griffin Hospital receives this year's Sodexho Marriott award for patient service.
The Healthy Beginnings program was launched in 1995 as a response to health plan mandates that new mothers be discharged 24 hours after vaginal delivery and 48 to 72 hours after a Caesarean section. Obstetrics nurses were frustrated that mothers and babies did not receive adequate care.
"I think I reach more patients this way," says Luanne Miller, supervisor of the childbirth center. "Sometimes, especially with the one-day stay, I felt I was very rushed and not providing the care or patient education that I needed to do."
Even after health plans were required by law to increase coverage to 48 hours after vaginal delivery, the program has continued to have a high response rate.
The obstetrics nurses got the idea for the program by brainstorming ways to help new mothers and their babies. The staff discussed providing home visits as another alternative, but scheduling and other pragmatic issues were roadblocks, says Mary Ann Bertini, a registered nurse and unit administrator.
The one-hour return visits add about 550 hours per year to the workloads of the obstetrics nursing staff, but nurses did not want extra compensation.
"(The program) is run completely by the nursing staff, with universal hospital and physician support," says Bill Powanda, vice president of Griffin Hospital. "They maintained complete ownership of the service from time of inception until today. The administration didn't know anything about (the project) until it was presented to us for our endorsement. It was an easy decision for us to make as administrators. Improving quality care with no added cost to the system: What better formula for success can you have than that?"
The nurses also developed an assessment form-with questions about the babies and the mothers-to use during the return visit. A resource area was added to offer literature about the care of newborns.
The nurses say they have been surprised at the number of problems they have uncovered. Sixteen percent of the babies have suffered from jaundice, and 10% have lost weight. The mothers have experienced incision problems, postpartum depression and hemorrhoids.
Equally important, nurses say, is the chance to answer the mothers' questions.
"Moms are in a more receptive mood a few days after discharge," Miller says. "I like seeing them because they've had time to go home and sort everything out, so they come up with a lot of good questions and advice we can give to other moms. Sometimes (new mothers) just need someone to talk to; they want to express their feelings and concerns and be reassured that what they did in the labor process was OK."
The program also has decreased late-night calls to the obstetrics unit and calls made by parents to pediatricians, Bertini says.
Judges of the service excellence awards were impressed with the program because it responded to changes and demands in healthcare.
"What I liked about (the project) was that it was responsive to the environment and marketplace," says Mark Clement, president and chief executive officer at Chicago-based Holy Cross Hospital. "It was innovative. It improved quality, improved service and was responsive to the economic challenges that hospitals were responding to. It was a triple win."
Healthy Beginnings is part of the hospital's Planetree philosophy of care. Planetree was begun 20 years ago to help change the way medical care is delivered. Through the model, healthcare facilities find ways to empower patients and change their architecture to become more patient-friendly. Griffin became the first affiliate member of Planetree in 1992. In January 1998, the hospital acquired the Planetree model.
"Planetree eliminates barriers between nurses, providers and patients," Powanda says. "It empowers patients to become involved in their care and empowers staff in their relationship to patients. Some of that empowerment results in the staff having a much different relationship with patients. Patients and nurses bond. They build a relationship. Some of that philosophy prompted and served as a catalyst for the Healthy Beginnings return program."