We have demonstrated that infants cared for in a few hospitals in one region can be discharged earlier through the institution of a mulitdisciplinary case management team. This same guidleline was instituted in many hospitals utilizing a disease management system (DM). We determined the effectiveness of instituting this guideline by comparing the discharge weights of infants in the time before (PRE) and after (POST) implementation of this guideline.

Methods: Infants cared for by DM in a neonatalintensive care unit (NICU) in three major metropolitan areas with a birthweight greater than 750 grams and less than 2000 grams were evaluated, and excluded if they had major surgical intervention. The guideline, which was approved by regional physician advisory boards, suggests the discharge of medically stable preterm infants at approximately 1800 grams as outlined in the pilot project, as appropriate. Patients managed from 7/1/96 through 4/30/97 were classified as PRE, and from the inception data of the guideline, 5/1/97, through 11/30/97 were classified as POST. We compared discharge weight and length of stay (LOS) in PRE versus POST populations by Student's t-test. All data expressed as mean {plusminus] SD. Results: A population of 236 infants were evaluated. Sixty-four infants PRE (birthweight 1572±303 grams) and 172 infants POST (birthweight 1454 ±368grams) (p<0.05). Discharge weight was significantly lower POST (1769±427 grams) versus PRE (1915±262 grams) (p<0.0001). LOS was greater POST (38±19 days) than PRE (30±21 days) (p<0.03). Conclusions: These data demonstrate that a practice guideline endorsed by a physician advisory board can be successfully and broadly implemented. While discharge weight decreased significantly post-implementation, the average LOS increased. This is explainable, in part, by a decrease in birthweight in infants during the POST study period. Determinants of LOS are complex, and the evaluation of the impact of a guideline needs to be multifactorial.