One of the goals of practice guideline is to unify the timing of nursery discharge. We speculated that an effectively instituted guideline would reduce variability in length of stay (LOS). A guideline for the management of term neonates with sepsis ruled-out was instituted by a disease management system(DM) in three major metropolitan areas.

Methods: Patients managed by DM were evaluated if they were greater than 35 weeks gestation and met eligibility for the asymptomatic neonatal sepsis clinical management guideline. This guideline suggested serial complete blood counts for the first 24 hours in infants at risk, and treatment for 48 hours pending a decision for prolonged course. We evaluated infants who were classified as sepsis ruled-out. Under this guideline there would be no need for LOS of 5-6 days based on the sepsis evaluation alone. Patients were subdivided by LOS into 2-4 days (implying guideline adherence) and 5-6 days. The guideline was approved by regional physician advisory boards. Infants with a diagnosis indicating eligibility were identified, and the pre-guideline population (2/1/97-6/30/97) was compared with the post-guideline population(7/1/97-11/30/97) using a chi-square analysis.

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