Australian and New Zealand Journal of Obstetrics and Gynaecology 2003; 43: 207–212 207 Blackwell Publishing Ltd. Original Article Day care for hypertension in pregnancy Cost-effectiveness and patient satisfaction with pregnancy day care for hypertensive disorders of pregnancy Lisa DUNLOP, 1 Mark UMSTAD, 1 Gabrielle MCGRATH, 1 Karen REIDY 1 and Shaun BRENNECKE 2 1 Department of Perinatal Medicine and 2 University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, Victoria, Australia Abstract Objective: To quantify the cost-effectiveness of, and evaluate patient satisfaction with, day care for management of hypertensive disorders of pregnancy. Design: Retrospective descriptive study. Setting: Pregnancy Day Care Centre, Royal Women’s Hospital, Melbourne. Sample: A total of 1200 consecutive women attending with a hypertensive disorder of pregnancy. Methods: Sociodemographic details and perinatal outcome were entered in a purpose designed computer program. A satisfaction questionnaire was administered to 130 women. Clinical costing data were calculated by casemix analysts to compare traditional inpatient and day care models of care. Results: An admission to the Pregnancy Day Care Centre cost an average of $684.85 less than a traditional inpatient admission. Women had an overwhelming preference for day care. Conclusion: Pregnancy day care is a cost-effective method of providing care for women with hypertensive disorders of pregnancy. Women prefer day care to inpatient care. Key words: day care, hypertension, pregnancy. Introduction Pregnant women are admitted to hospital for one of three reasons: (i) to receive treatment that cannot be obtained at home; (ii) because they are at risk of an emergency compli- cation that requires rapid intervention; and (iii) for initial assessment and subsequent serial monitoring of maternal and fetal well-being. 1 The investigation of fetal well-being entails undertaking tests (such as fetal cardiotocography and/or ultrasound examination) which can nearly always be carried out within a short period of time. For many clinical indications, if the results are normal, the tests will not need to be repeated. With other complications in pregnancy serial investigation is required. Therefore, assessment of maternal and fetal well- being can be often provided in a day care setting as long as the patient is mobile and lives within a reasonable distance from the hospital. 2,3 Traditionally, women with hypertension in pregnancy have been admitted to hospital for rest, assessment and treat- ment. The introduction of day care units has been seen as means of reducing inpatient workload and costs. 4 Pregnancy day care is an innovative model of antenatal care in which an overnight and prolonged inpatient stay for many pregnancy complications is replaced by a short stay admission. In recent years, pregnancy day care units have been established in many maternity centres to enable expeditious evaluation and management of clinical conditions including hypertensive disorders of pregnancy, hyperemesis gravi- darum and preterm prelabour rupture of the membranes. Day care avoids the need for time-consuming, socially dis- ruptive and expensive overnight hospital admissions. The aim of the present project was to evaluate the impact of the Royal Women’s Hospital (RWH) Pregnancy Day Care Centre (PDCC) on the provision of healthcare for women who experience hypertensive disorders of pregnancy. In assess- ing this model of care we intended to assess the economic Correspondence: Dr Mark Umstad, Suite B, Level 10, The Royal Women’s Hospital, 132 Grattan Street, Carlton, Victoria 3053, Australia. Email: mark.umstad@maynegroup.com Received 27 September 2002; accepted 6 February 2003.