Nursing staff ratios directly impact pediatric hospital readmissions

There is a direct link between nursing staff ratios and hospital readmissions for children with common medical and surgical conditions, according to a new study in the online journal BMJ Quality and Safety in Health Care.

The study, led by a nurse scientist at Cincinnati Children's Hospital Medical Center, is believed to be the first of its kind to examine the extent to which hospital nurse staffing levels are related to pediatric readmissions. The study examined common medical and surgical conditions, such as pneumonia and appendectomy, and pediatric readmissions.

The publication of the study comes in the wake of the introduction last month of proposed federal legislation mandating nursing staffing ratios across the country.

The study found that an increase of only one patient in a hospital's average staffing ratio raised the likelihood of a medical patient's readmission within 15-30 days by 11 percent. But the odds of readmission for surgical patients increased by 48 percent.

Children treated in hospitals meeting a staffing benchmark of no more than four patients per nurse were significantly less likely to be readmitted within 15-30 days. Nursing staffing ratios had no effect on readmissions within the first 14 days after discharge.

The study team looked at the outcomes of more than 90,000 children in 225 hospitals using survey and discharge data from California, Florida, New Jersey and Pennsylvania, as well as the American Hospital Association Annual Survey from these four states, according to a statement published by EurekAlert. All hospitals included in the study were non-federal, acute-care facilities with at least 50 pediatric discharges a year.

"Lower patient-to-nurse ratios hold promise for reducing preventable readmissions by allowing for more effective pre-discharge monitoring of patient conditions, improving discharge preparation and through enhanced quality improvement success," Heather Tubbs-Cooley, Ph.D., a nurse scientist at Cincinnati Children's and the study's main author, said in the statement.

"Delivering high quality patient care requires nurses' time and attention, and better staffing conditions likely allow nurses to thoroughly complete the clinical care that children and their families need in order to have a successful discharge," she added.

Despite the study results, Tubbs-Cooley isn't jumping on the bandwagon for mandated staffing ratios. "We have abundant evidence that better nurse staffing levels in hospitals are associated with better patient outcomes, but we lack robust data to guide decision-making regarding optimal staffing levels for a given unit or patient population," she said.

In order to obtain that data, Tubbs-Cooley plans to test different research designs and methods than those the industry has relied on in the past.

To learn more:
- read the study
- read the statement
- read about  the proposed legislation