"Unnecessary early discharge"

Whilst the midwives that cared for me during the stay were mostly fantastic, caring and very helpful, I feel the same cannot be said for management. All of this changed on the day of discharge which I felt was done so in a rush and passively insisting that the patient did not have a choice.

Prior to admission into KEMH, care with Psych Med had been involved to manage the pregnancy. Unfortunately, following what I felt was a more (than usual) complex caesarean section, the talk of discharge began <40h following surgery. The patient was only just starting to begin standing (no more than a few steps possible) following a visit to the NICU the night before in a wheelchair. Shortly after the morning rounds on day 2, it seemed an influx of staff were ready to rush through discharge procedures and medications for home. Although the general observations were improving, I felt no-one really stopped to ask if the patient was actually mentally and physically ready. Seriously, in less than 40h? There were other C-section patients that I believe were personally spoken to with planned C-sections who couldn't wait to leave after 5 days in the ward (co-sharing with newborn).

Yet, I felt this patient would not have even dared or known to have said otherwise when confronted in what I felt was such an overwhelming manner that one would feel obliged to be discharged without even being able to stand up for themselves; adding to further separation from the newborn.

How can the hospital be proud of its values if, based on this experience, the basic patient-focused care can't even be completed? In combination with a somewhat unexpected preterm delivery, a private patient (choosing to support the hospital's objectives of building resources and education, whilst the hospital reaps the benefits at the expense of patient care) had to face discharge with separation from baby, compounded with greater restricted movement (advised 6 to 12 weeks recovery) and psychological impact which I believe is well documented (use keywords: 'PTSD', 'preterm' or similar in pubmed) to have significant impact on PTSD/PTS for a parent with a preterm infant in NICU. I feel this is of significant concern when the risk is already high when the appropriate antenatal care had already been recorded and flagged. What's the point of having 'patient's medical history' in the notes, if not even referred to on an individual basis for discharge?

The unfortunate result of rushing the discharge also immediately caused a panic attack.

Did anyone then consider delaying discharge perhaps even for one night? What is it really going to cost the ward vs the long term implications to the mother's mental health and subsequently the baby’s health in NICU, if the mother can't even feel supported. Yet, the mother currently experiences being discharged with feeling abandoned, rushed, unsupported, unable to even bond with the baby (cuddles were not possible overnight due to baby's condition), unable to have any sort of routine to encourage breastfeeding/expressing which is also well documented to be delayed following a C-section. Yet, evidence (example: https://journals.sagepub.com/doi/full/10.1177/0973217920922398) indicates that factors such as physical separation, maternal health, stress of baby in NICU, lack of proper counselling are barriers in providing expressed breast milk. It seems like an interesting way to advocate for breastfeeding from a BFHI accredited hospital, in particular steps 7,8, 10 in KEMH’s procedures.

The most surprising factor is that the discharge was also completed prior to follow-up visit from Psych Med to ensure the patient's well-being which I believe is actually one of the policies when discharging a patient (to consider medical history and if safe to do so). How can discharging a patient be rushed when it was evident other mothers could not wait to be discharged 5-days post-surgery? Why wasn’t the affected patient assessed on an individual basis? It seems to me that clearly steps of care were missed and rushed. I feel this has now led to a negative outcome of a detriment to the patient’s condition.

So why does this continue to happen and why should it? Especially in an already vulnerable individual. What's the point of having NMHS/WNHS values?

"Our Values- Care, Respect, Innovation, Teamwork and Integrity."

"Our Vision -Excellence in healthcare for women, infants and their families"

"Strategies- 1. Clinical excellence and improved health care outcomes. 2. Centres of excellence. 3. Engage carers, consumers, clinicians and community. 4. Effective supports to enable best practice, next generation care. 5.Enable and empower our people."

As far as I’ve experienced, it's all about managing numbers, not being true and practicing the values and vision claimed by the Health Organisation itself. Speaking to other health professionals, all are appalled by this known practice, yet not surprised to its ongoing nature.

Why should women, infants and families have to potentially suffer more? Please spare the apology; I would like to know what will the representative of this organisation do to address this matter for change? Why do the affected families like mine have to feel the burden and then increase the burden back onto the health system all for what I believe to be the sake of a number. For the cost of this number, I believe the long-term implications in potentially many other cases would be far greater than the extra bit of 'care' that could have been provided to prevent all of this.

Does one need to wait for a traumatic/fatal case before attention is placed intervene and prevent the ongoing lack of care? Is this the strategy for claiming to promote healthcare whilst billing insurance companies for incomplete care and claiming to "enhance the patient experience", whilst the “funds are used to develop and improve hospital equipment and facilities”?

Unfortunately, as I scroll through Care Opinion, I am disgusted by the number of similar stories reported at KEMH.

I sincerely hope that this care opinion is escalated to the executives and higher. Could you please reply with what steps are going to be taken to mitigate this within 14 days.