December 17, 1997

Early Discharge of Newborns-Reply

Author Affiliations

University of California, San Francisco
Harvard Medical School Boston, Mass
US Department of Health and Human Services Washington, DC

JAMA. 1997;278(23):2067. doi:10.1001/jama.1997.03550230043033

In Reply  —Drs Cass and Volk suggest that the NNT concept should be applied to inform decisions about the trade-offs between postpartum hospital days and newborn readmissions. Based on findings from the studies by Dr Liu and colleagues' and by Dr Edmonson and colleagues,2 they calculate that society and insurers would be expected to pay for an estimated 232 additional days of postpartum hospitalization to save an estimated 2.5 newborn readmission days. We believe that framing decisions about early discharge in terms of a trade-off between LOS and newborn readmissions oversimplifies the relationship between services and outcomes. The experiences of Dr Cook and colleagues, who describe the range of services associated with a voluntary early-discharge program offered by their managed care organization in Connecticut, suggest that we should consider the full span of relevant services actually received by mothers and infants before, during, and after the postpartum hospital stay, rather than