Reuters: "Home Nurse Visits Improve Newborn Health"
October 7, 2004 -- Today a Reuters piece by Anthony J. Brown, MD, reported that a new study published in the October issue of the journal Pediatrics found that home health nurse visits a few days after a woman gives birth reduce "the number of newborns being readmitted to the hospital with jaundice or dehydration--and it saves money." The article is a fairly good, if short, summary of the key findings of this study, which underlines the importance of home health nurses in an era of shorter hospital stays and widespread hospital nurse short-staffing, both of which may reduce patients' access to vital nursing care that can prevent such problems. We commend Dr. Ian Paul of the Penn State Children's Hospital and his colleagues for performing the study, and Dr. Brown for reporting on it.
In the study, researchers analyzed data as to about 3,000 babies born between 2000 and 2002 at the Hershey Medical Center in Pennsylvania. Only about 11% of these babies received a home nurse visit. Researchers found that rates of hospital readmission for jaundice or dehydration in the first 10 days of life was 2.8% for the non-nurse group but only 0.6% for the nurse group, and that the corresponding rates of emergency room visits for the two groups during that same period were 3.5% and 0%. Yes, zero ED visits for the nurse group. The study also found significant per-infant cost savings with the nurse-visit group, even though the nurse visits always cost about $85 and only a small percentage of the non-nurse group actually did return to the hospital, because ED visits typically cost around $400 and hospital admissions about $4,000. The piece also included several quotes from lead study author Dr. Paul, who noted that infants often do not receive the recommended pediatric follow-up three or four days after delivery, and that the home nurse visits provide a "bridge over the gap between nursery care and primary care." He also noted that the home health nurse visits were already "standard of care" in England, parts of Canada, and other nations.
The piece might have included commentary from an actual home health nurse, and also could have benefited from a few additional contextual points. It did not mention the increasing importance of home health nurse visits in post-natal and other contexts, given financial pressures on hospitals that have effectively resulted in a "denursification" that threatens patient wellbeing. The piece might have noted that a critical cause of jaundice and dehydration in newborns is some new mothers' difficulty in breastfeeding, a problem that can be exacerbated when patients are sent home precisely when the mother's milk comes in and breastfeeding challenges are greatest. The story could have also noted that nurses are relatively well-positioned to advise new mothers on this situation and/or refer them to expert lactation consultants. Finally, the piece might have noted that jaundice and dehydration are not just costly and unpleasant conditions, but that dehydration can be life-threatening and jaundice can cause life-long debilitation.
See the Reuters article. The New York Times ran a similar, fairly good summary of the study results by John O'Neil, which even included a comment by Dr. Paul on the breastfeeding point. However, like Reuters the Times failed to explain the life saving nature of the home health nursing intervention, a failure that was not mitigated by the flippant header: "Practices: Nurses Keep Babies Bouncing."
See the study:
Ian M. Paul, MD, MSc*, Troy A. Phillips, MHA, Mark D. Widome, MD, MPH* and Christopher S. Hollenbeak, PhD. "Cost-Effectiveness of Postnatal Home Nursing Visits for Prevention of Hospital Care for Jaundice and Dehydration" Pediatrics Vol. 114 No. 4 October 2004, pp. 1015-1022.