Opportunity

The postpartum length of stay (LOS) for a routine vaginal delivery is typically three days. That may not sound like a long time; however, many new parents want to be in the comfort of their own homes, recovering and bonding with their babies as quickly as possible after delivery. In fact, a 2018 survey at the Hospital of the University of Pennsylvania (HUP) found that 80 percent of low-risk patients who had vaginal deliveries were amenable to going home one day sooner. 

Regardless of when discharge occurs, numerous challenges can arise in the weeks following birth, also known as the fourth trimester. Clinical considerations during this time are complex. Patients can experience everything from typical recovery symptoms to potentially dangerous complications that can lead to death. 

In 2018, when this project began, the American College of Obstetricians and Gynecologists (ACOG) released new guidelines advising that postpartum care should become an ongoing process rather than a single encounter, with services and support tailored to each patient's individual needs.

Intervention

Healing at Home supports the postpartum needs of parents and babies in the setting they prefer using a two-pronged approach. 

First, the program gets eligible patients home sooner by implementing an expedited discharge process. Historically, health screenings have been completed for new babies 36 hours after birth. Healing at Home moves screening up to 24 hours, enabling patients and their babies to be ready for discharge one day after delivery rather than two. 

Next, Healing at Home introduces a text-based automated postpartum chatbot that bridges the gap in fourth-trimester care by providing new parents with around-the-clock access to clinical guidance. The chatbot fields questions and concerns, provides just-in-time education, facilitates more efficient lactation support and postpartum depression screening, and escalates triage to higher-value care if necessary.

Impact

During initial pilots at HUP, Healing at Home safely decreased LOS by 40 percent, with zero postpartum emergency department visits or readmissions among participants. And an analysis conducted by the team showed that the program's automated chatbot correctly and automatically answered 80 percent of patient inquiries – giving parents peace of mind and reducing the burden on busy providers so that they could focus on more acute issues. 

Based on these results, Healing at Home was implemented as a clinical program at HUP in March 2020. 

Currently, the team is working on expanding and enhancing the program. Efforts include:

• Piloting at Pennsylvania Hospital and other Penn Medicine hospitals,
• Development of a Spanish version of the program,
• Expansion of clinical content to support patients delivering babies who were born preterm,
• And piloting a long-term postpartum depression screening pathway that follows participants' mental health for one year.

At scale, Healing at Home has the potential to improve the postpartum experience for more than 16,000 Penn Medicine patients annually, setting the stage for the long-term health and well-being of new parents and their babies.