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dc.contributor.authorBowers, Johnen_UK
dc.contributor.authorCheyne, Helenen_UK
dc.description.abstractBackground  UK health services are under pressure to make cost savings while maintaining quality of care. Typically reducing the length of time patients stay in hospital and increasing bed occupancy are advocated to achieve service efficiency. Around 800,000 women give birth in the UK each year making maternity care a high volume, high cost service. Although average length of stay on the postnatal ward has fallen substantially over the years there is pressure to make still further reductions. This paper explores and discusses the possible cost savings of further reductions in length of stay, the consequences for postnatal services in the community, and the impact on quality of care.  Method  We draw on a range of pre-existing data sources including, national level routinely collected data, workforce planning data and data from national surveys of women’s experience. Simulation and a financial model were used to estimate excess demand, work intensity and bed occupancy to explore the quantitative, organisational consequences of reducing the length of stay. These data are discussed in relation to findings of national surveys to draw inferences about potential impacts on cost and quality of care.  Discursive analysis  Reducing the length of time women spend in hospital after birth implies that staff and bed numbers can be reduced. However, the cost savings may be reduced if quality and access to services are maintained. Admission and discharge procedures are relatively fixed and involve high cost, trained staff time. Furthermore, it is important to retain a sufficient bed contingency capacity to ensure a reasonable level of service. If quality of care is maintained, staffing and bed capacity cannot be simply reduced proportionately: reducing average length of stay on a typical postnatal ward by six hours or 17% would reduce costs by just 8%. This might still be a significant saving over a high volume service however, earlier discharge results in more women and babies with significant care needs at home. Quality and safety of care would also require corresponding increases in community based postnatal care. Simply reducing staffing in proportion to the length of stay increases the workload for each staff member resulting in poorer quality of care and increased staff stress.  Conclusions  Many policy debates, such as that about the length of postnatal hospital-stay, demand consideration of multiple dimensions. This paper demonstrates how diverse data sources and techniques can be integrated to provide a more holistic analysis. Our study suggests that while earlier discharge from the postnatal ward may achievable, it may not generate all of the anticipated cost savings. Some useful savings may be realised but if staff and bed capacity are simply reduced in proportion to the length of stay, care quality may be compromised.en_UK
dc.publisherBioMed Centralen_UK
dc.relationBowers J & Cheyne H (2016) Reducing the length of postnatal hospital stay: implications for cost and quality of care. BMC Health Services Research, 16 (1), Art. No.: 16.
dc.rights© Bowers and Cheyne. 2016 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.en_UK
dc.subjectPostnatal careen_UK
dc.subjectEarly hospital dischargeen_UK
dc.subjectLength of stayen_UK
dc.subjectCost savingsen_UK
dc.subjectCare qualityen_UK
dc.titleReducing the length of postnatal hospital stay: implications for cost and quality of careen_UK
dc.typeJournal Articleen_UK
dc.citation.jtitleBMC Health Services Researchen_UK
dc.type.statusVoR - Version of Recorden_UK
dc.contributor.funderScottish Governmenten_UK
dc.contributor.funderRoyal College of Midwives Scotlanden_UK
dc.contributor.funderTechnology Strategy Boarden_UK
dc.contributor.funderRoyal College of Midwivesen_UK
dc.contributor.affiliationManagement, Work and Organisationen_UK
dc.relation.funderprojectKnowledge Transfer Partnership between University of Stirling and The Royal College of Midwivesen_UK
dc.relation.funderprojectCommunity Postnatal Care Resource Allocation Model (PRAM)en_UK
rioxxterms.typeJournal Article/Reviewen_UK
local.rioxx.authorBowers, John|en_UK
local.rioxx.authorCheyne, Helen|0000-0001-5738-8390en_UK
local.rioxx.projectKTP008934|Royal College of Midwives|
local.rioxx.projectKTP008934|Technology Strategy Board|
local.rioxx.projectPRAM|Royal College of Midwives Scotland|en_UK
local.rioxx.projectPRAM|Scottish Government|
local.rioxx.filenameBowers and Cheyne_BMC Health Services Research_2016.pdfen_UK
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