Standardizing documentation and the clinical approach to apnea of prematurity reduces length of stay, improves staff satisfaction, and decreases hospital cost

Jt Comm J Qual Patient Saf. 2014 Jun;40(6):263-9. doi: 10.1016/s1553-7250(14)40035-7.


Background: Apnea of prematurity, a common disorder, can severely compromise an infant's condition unless correctly diagnosed and treated. Infants with a history of apnea of prematurity can be discharged home but then be rehospitalized for an apneic event, an apparent life-threatening event, or sudden infant death syndrome. The definition of a clinically significant cardiopulmonary event, such events' documentation, and the treatment approach were standardized, and discharge criteria were refined.

Methods: A prospective, single-center comparison was conducted between a group of premature infants before and after implementation of the standard approach. Data were collected prospectively from August 1, 2005, through July 21, 2006, for the prestandard-approach group and from August 1, 2006, through September 16, 2007, for the standard-approach group.

Results: Twenty-two (35%) of the 63 infants in the prestandard-approach group experienced discharge delays because of poor documentation, whereby the clinician could not determine the safety of discharge. This resulted in 59 additional hospital days (mean length-of-stay [LOS] increase, 5.7 days). The standard-approach group of 72 infants experienced no discharge delays and no additional hospital days, and LOS decreased (all p < .0001). Annual charges were reduced by more than $58,000 in avoiding unnecessary hospital days. Readmission to the hospital for apnea of prematurity occurred for 5 (7.9%) of the prestandard-approach group but none of the standard-approach group (p = .0203). Overall compliance with the standardization process has been maintained at > or = 96%.

Conclusion: Implementation of a standard approach to the definition of apnea of prematurity and its treatment and documentation decreases LOS and reduces cost.

MeSH terms

  • Apnea / economics
  • Apnea / therapy*
  • Caffeine / administration & dosage
  • Central Nervous System Stimulants / administration & dosage
  • Documentation / methods*
  • Gestational Age
  • Hospital Costs
  • Humans
  • Infant, Premature*
  • Inservice Training / organization & administration
  • Job Satisfaction
  • Length of Stay / statistics & numerical data
  • Monitoring, Ambulatory
  • Patient Discharge*
  • Prospective Studies
  • Quality of Health Care / organization & administration


  • Central Nervous System Stimulants
  • Caffeine