The Case for Day Case: Reduced Inpatient Stays with the use of Day Case Management in Hyperemesis Study

Abstract

Background: Hyperemesis gravidarum (HG) is a major health burden affecting between 1-2% of all pregnancies. The sequelae of the condition can be fatal. There is current equipoise as to how best to manage the condition; that is inpatient versus outpatient management. Objective: This study investigated the total length of stay for patients diagnosed with HG, comparing those who were managed as inpatients as opposed to those managed in a day case setting. A case control methodology was utilized. Two tertiary referral centres for HG of similar size and demographic were selected. One preferentially used day case management. The other uses inpatient management. Results: In total 61 day, case managed patients and 91 inpatient managed patients were recruited to the study. Adjusting for readmission, total length of stay was 4.08 days for inpatient managed patients compared to 0.39 days for day case managed patients (p=0.0002). Conclusion: Day case managed patients for HG have a significantly shorter length of stay. There is no predictive value in the reviewed serum biomarkers as to the likelihood of re-admission.