THE early discharge system originates in developed countries as a mitigation mechanism for decongesting hospitals. In the United Kingdom it has been practiced as early as 1980 particularly involving stroke patients.
However, these policies involved adult patients, not children, much more postnatal infants. In the United States, reviews of earlier studies, such as the Brown and colleagues study in 2002 on postnatal early discharge practice (less than 48 hours post-delivery), failed to establish the benefits against hospital readmission. Gupta and colleagues reported the same situation in 2006 (Indian Journal of Pediatrics).
In the Philippines, particularly in Cebu, the policy was already practiced as early as 2004, according to the Iran study of Vicente Sotto Medical Memorial Hospital, published in the Philippine Journal of Pediatrics. In 2015, Gemma Maranian of Davao Regional Hospital (DRH) and Feliciano Yamas of the Medical Mission Group Hospital appeared to notice no evident benefit on readmission from published studies around the world.
Their review on the DRH early discharge policy, however, revealed something new in the known literature. The policy had increased the readmission rate among newborns by 3.2 percent when discharge occurred earlier than 24 hours of birth. The readmission ages were also younger (nine days old average) than before (11.5 days old average), which is a difference of 2.5 days or 60 hours. More than 97 percent of these newborns came from Davao del Norte and the Compostela Valley.
The results, however, are logically interesting. It is logical to presume that the early discharged newborns should be younger when readmitted than those who were discharged later. The early/not early difference, however, is only an average of 20 hours. Mathematically, it appears that for every hour of early discharge postponement, the more newborns will be readmitted three hours older thereafter. Thus, the longer the newborn is discharged, the greater chances she may be readmitted thrice older. If we assume that older infants tend to be less vulnerable to sickness, then the longer the discharge is, the more likely readmission may not be necessary later.
This study provides an important proof that early hospital discharge of newborns may not be that good for their health, at least in Davao, that is. And, to consider that it was an average of only 20 hours difference, why does it matter really to discharge the infants after 37 hours or 48 hours if readmission may not be necessary later on?
One important difference however, for parents, is the cost. But, how high is the cost of another day in a government hospital, really, if the child has to be readmitted in less than a month? For the hospitals, the advantage is clear: More patients to serve.