Safety and cost-effectiveness of managing patients at risk for immediate preterm delivery on a minimum care unit

Objective: To evaluate the safety and effectiveness of managing pregnant women with 1) preterm, premature rupture of the membranes, 2) preterm labor with advanced cervical dilitation and effacement, and 3) complete placenta previa on a minimum care unit obviating the need for routine hospitalization. Methods: After obtaining informed consent, patients with the above noted diagnoses were placed in a minimum care unit with close proximity to labor and delivery (Perinatal Access and Support Services [PASS Program]). Physicians saw the patients on a regular weekly basis, while nurses saw the patients daily. The majority of each patient’s care and daily assessment was performed by the patient, herself, much as if the patient was discharged to home. Neonatal outcome was assessed and a cost comparison between routine hospitalization and utilization of the minimum care unit was calculated. Results: Sixty-one patients consented to participate in the PASS program. The mean gestational age on admission vs delivery was 30 4/7 weeks vs 31 5/7 weeks for patients with premature rupture of the membranes and 29 3/7 weeks vs 34 4/7 weeks for patients with preterm labor and advanced cervical dilatation. All complaints resulting in a transfer to labor and delivery were initiated by the patient and not the nurse or physician provider. All four neonatal deaths were due to complications of immaturity (gestational ages <24 weeks). There were no intrauterine fetal demises on the minimum care unit. Utilization of this program saved over $220,000 in hospital costs. Conclusion: The PASS program is a safe, cost-effective alternative to routine hospitalization for patients who do not need routine hospitalization but who must have immediate access to labor and delivery.