Collaboration is often necessary to take care of postpartum readmit patients

Rationales (colored lines match specific colored rationale):
Collaboration is often necessary to take care of postpartum readmit patients. In addition to nursing staff
working with the providers, there is also support needed from Lactation consultants (meso) to assist
these postpartum mothers and the nursing staff with breastfeeding and pumping. Some patients are not
physically able to take care of their newborn during their readmission, so collaboration is needed to
assist these patients with pumping to allow continued breastfeeding. For those patients able to take
care of their newborns during the readmission period, it is crucial for the hospital and unit to have a
policy on allowing rooming-in (meso) between the mother and infant.
During high census periods (macro), especially during the summer on Labor and Delivery, there are
often more antepartum and laboring patients being admitted. As postpartum readmission rates
increase, more Labor and Delivery beds (micro) will be allocated for postpartum readmits. Postpartum
readmissions are kept on the Labor and Delivery unit for closer monitoring and oftentimes one-on-one
nursing support due to the severity of the patient’s diagnosis. Thus, more Labor and Delivery nurses
(micro) are needed to care for these postpartum patients, which decreases the nurses available to take
care of laboring patients, especially during high census times.
A lack of adequate follow up care (macro) in the immediate postpartum period may lead to increased
hospital readmission rates for postpartum mothers. This primarily may be due to a lack of surveillance
and early intervention to complications during this period if the patient is unable to obtain follow up
care in an office-setting with a healthcare provider. Many hospitals use readmission rates as a quality of
care indicator (macro), which is usually also reported at a state and national level and for Medicare and
Medicaid services. In cases where readmission may be preventable with early intervention, but a patient
does not have access to follow up care, readmission rates may increase due to the patient seeking care
at a hospital once their complications worsen.
Again, if a patient does not have adequate access to follow up care (macro), they may unknowingly
allow mild complications that could have been treated with early intervention to worsen to the case of
hospitalization and readmission. The longer an individual waits to seek care, therefore allowing their
issues to worsen, the greater the chance for increased morbidity and mortality. As maternal mortality
rates have increased across the country (macro), it is an area of concern among intrapartum and
postpartum patients. Sufficient access to care and early interventions to complications may be critical in
helping to reduce these maternal mortality rates.
Upon initial discharge from the hospital post-birth, patients should be sufficiently educated (micro) on
when to follow up with their physician in the office, signs and symptoms to report to their doctor, and
when to seek immediate medical assistance. The hope is that with sufficient patient education upon
discharge, readmission rates will decrease by encouraging patients to seek early care with their
physician in the office and not allowing their symptoms to worsen to the point that they will need to
follow up in an emergency department or obstetrical triage department. However, patients who have a
lack of follow-up care or do not obtain substantial patient education on initial discharge may seek
treatment in an emergency department or obstetrical triage (meso). This then increases the number of
postpartum patients in a triage area that is also assessing laboring and antepartum patients.
Furthermore, maternal mortality rates (macro) may increase with longer waiting periods in emergency
departments while patients are waiting to be seen to treat their postpartum complications.
There are multiple ways to set patients up for success upon initial discharge from the hospital post-birth.
In addition to thorough education (micro), nurses and physicians should be monitoring the patient’s vital
signs and lab values (micro) prior to discharge to understand if there are any abnormal values that might
indicate the beginning of postpartum complications. If we can catch these abnormal values prior to
delivery, we might be able to provide early intervention and save the patient from being readmitted to
the hospital following discharge. Another important factor is working with pharmacy (meso) to provide
patients with crucial medications or monitoring equipment to take home with them when discharged
from the hospital. This can save them a trip from obtaining these items post-discharge, especially for
patients who have a lack of transportation (micro). For patients who have a lack of access to follow-up
care (macro), the opportunity to take medications and a blood pressure cuff home with them might save
them from complications later on by allowing early detection and treatment of problems while they are
at home.