Marquette professors find nurse staffing, overtime hours affect readmission rates, emergency room visits

April 25, 2011 - MILWAUKEE - A new study published in the current issue of Health Services Research finds that  having more registered nurses working on a hospital unit and reducing the amount of R.N.s' overtime hours are correlated with fewer patients being readmitted or visiting the emergency department within the first 30 days after hospital discharge, and also reduced costs. The study also found a positive correlation between the number of R.N. staffing hours and patients' satisfaction with the quality of discharge teaching and subsequent readiness to go home.

Marianne Weiss, D.N.Sc., R.N., associate professor and Wheaton-Franciscan Healthcare/Sister Rosalie Klein professor of women's health at Marquette University College of Nursing, is one of the lead investigators of the study, which was funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. She led an interdisciplinary team that included Olga Yakusheva, Ph.D., assistant professor of economics at the Marquette University College of Business Administration, and Kathleen Bobay, Ph.D., R.N., N.E.A.-B.C., associate professor of nursing at Marquette and research scientist at Aurora Health Care. The team studied nurse staffing levels, patients' reports on quality of the discharge teaching process and their readiness for discharge, along with post-discharge readmissions and emergency department visits for 16 medical surgical units at four hospitals in a single Midwestern health care system. The final sample included 1,892 patients.

Researchers found that when R.N. non-overtime staffing was higher, the likelihood of patient readmission was lower, and when R.N. overtime hours were higher, emergency department use was also higher. In addition, a cost-benefit analysis estimated that increasing non-overtime staffing by .75 hours per patient per day increased hospitals' cost by $197.92 per hospitalized patient but saved payers $607.51 per patient. Reducing R.N. overtime staffing by .07 hours per patient day resulted in hospital savings of $8.18 per hospitalized patient and $10.98 in savings per hospitalized patient to payers. Using a cost analysis projection for the 16 nursing units in the study, the researchers estimated an annual net savings of $11.64 million associated with increasing non-overtime hours and an annual net savings of $544,000 associated with decreasing overtime hours. However, in current payment models, payer savings accruing from reduction in readmissions or Emergency Department use would not be applied to offset hospital costs for increased nurse staffing.

"We know that patients who aren't properly prepared to be discharged are more likely to be readmitted to the hospital and we also know that if nurses have more hours allocated to work with patients, they have more time to perform critical functions that require R.N.- level expertise, like discharge teaching," said Weiss. "This study shows us that investing in nursing care hours could potentially be offset by the savings that could be realized in reductions in readmission and emergency department use."

The study's authors write that their findings support recommendations to monitor and manage unit-level nurse staffing to ensure optimal post-discharge results; implement assessment of the quality of discharge teaching and patients' readiness for discharge as part of the discharge procedure; and realign payment structures so that the cost of nurse staffing is offset by the savings that result from reductions in unplanned readmissions and emergency department visits after discharge.

Founded in 1936, the Marquette University College of Nursing has more than 7,000 alumni at the bachelor's, masters and doctorate levels making a difference in health care every day, nationwide. Marquette nurses embody the Jesuit traditions of living lives of faith, promoting excellence, becoming leaders and serving others.

INQRI supports interdisciplinary teams of nurse scholars and scholars from other disciplines to address the gaps in knowledge about the relationship between nursing and health care quality. It is helping to advance the recommendations of the Institute of Medicine's landmark report, The Future of Nursing: Leading Change, Advancing Health, which include fostering interprofessional collaboration and preparing and enabling nurses to lead change. By requiring research teams to include a nurse scholar and at least one scholar from another health care discipline, INQRI not only fosters interprofessional collaboration, the Initiative also ensures that diverse perspectives are brought to bear in research.

The Interdisciplinary Nursing Quality Research Initiative is funded by the Robert Wood Johnson Foundation. To learn more, visit, or follow on Twitter at @INQRIProgram.

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