Boosting nurse staff levels could reduce readmissions

Each added nurse hour per patient day lowered risk of incurring penalty by 10%

  • Don't miss: The Advisory Board's Jennifer Stewart offers her expert take on this study.

A new study in Health Affairs found that hospitals with higher nurse staffing levels were 25% less likely to incur Medicare readmissions penalties than their less well-staffed peers.

Study: More nurses mean fewer readmissions

For the study, researchers from the University of Pennsylvania School of Nursing studied nurse staffing levels and American Hospital Association (AHA) readmissions data from 2,826 hospitals. Researchers focused on Medicare beneficiaries who suffered heart attacks, heart failure, or pneumonia.

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According to the study's findings, hospitals with high nurse staff levels were less likely to be penalized by CMS for excess 30-day readmissions than hospitals with lower nurse staff levels. Moreover, hospitals with high nurse staff ratios were 41% less likely to receive the maximum penalty under the Medicare readmissions program.

Overall, researchers determined that adding one additional nurse hour per patient day lowered the hospital's risk of incurring penalties by 10%.

Findings could boost nursing union push for mandatory ratios

The country's largest nurses union—the National Nurses United—has pushed lawmakers to adopt legislation establishing minimum patient-to-nurse staffing ratios. The American Nurses Association also supports federal legislation for staffing ratios.

However, AHA has long opposed such mandatory ratios, citing concerns that requirements would be cumbersome and threaten small facilities.

"Our findings highlight a component of the hospital care delivery system that can be targeted to limit hospitals' exposure to readmissions penalties while improving patient outcomes," lead author Matthew McHugh writes in the study, adding that by "focusing on a system factor such as nurse staffing, administrators may be able to address multiple quality issues while reducing their likelihood of penalty for excess readmissions."

McHugh added that nurses are integral to reducing readmissions because they coordinate care, discharge patients, and educate their families about continuing care.

"It's rather intuitive that when they have adequate staffing and resources to carry out these activities properly, readmission rates decline," said McHugh, adding that the study "strongly supports the idea that nurse staffing is one key component of health care delivery that hospitals can address to both improve patient outcomes and reduce the likelihood of being penalized for excessive readmissions" (McHugh et al., Health Affairs, 10/1; Selvam, "Vital Signs," Modern Healthcare, 10/8 [subscription required]).

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