Increased nurse staff levels tied to lower odds of Medicare readmissions penalties, s

[herring_RN, ASN, BSN]

Nursing unions wanting higher staffing ratios have more ammunition thanks to a new study concluding that increasing nurse staffing levels could help hospitals avoid Medicare penalties for avoidable readmissions.

The study covered readmissions of Medicare patients who suffered heart attacks, heart failure or pneumonia. It appears in the October issue of Health Affairs. ...

... The researchers, led by Matthew McHugh, an associate professor at the University of Pennsylvania School of Nursing, looked at nurse staffing levels and readmission data from 2,826 hospitals. They found that hospitals with high nurse staff levels, as considered by researchers, had 25% lower odds of being penalized compared to facilities with lower nurse-staffing ratios. Higher-nurse staffed hospitals also had 41% lower odds of receiving the maximum penalty for readmissions. The study used American Hospital Association staffing data for the study.

The research team estimated that each additional nurse hour per patient day brought 10% lower odds of receiving penalties from the Hospital Readmissions Program, the federal effort that started in October 2012 and aimed to reduce the $15 billion in annual Medicare expenditures on preventable readmissions. Hospitals paid about $280 million in penalties for preventable readmissions in fiscal 2013....

... In a news release, McHugh said nurses are responsible for many activities associated with reducing readmissions, including coordinating care, overseeing care in the hospital, planning for patients' discharge from the hospitals, and educating patients and their families about what to do when they return home.

"It's rather intuitive that when they have adequate staffing and resources to carry out these activities properly, readmission rates decline. This study strongly supports the idea that nurse staffing is one key component of healthcare delivery that hospitals can address to both improve patient outcomes and reduce the likelihood of being penalized for excessive readmissions." ...

http://www.modernhealthcare.com/article/20131008/blog/310089995

[LadyFree28, BSN, LPN, RN]

Even nurses without unions have EBP-ALL nurses need to force the hand of the bottom line.

[mindlor]

Yet another study to try to answer a question that has an obvious answer. Better staffing ratios will improve every measurable data point.....

its really kind of a duh????? thing......

[HouTx, BSN, MSN, EdD]

Thank you for sharing this important information.

[neonurse97]

Hospitals don't want to hear this though.

[merlee]

WHAT WE NURSES HAVE BEEN SAYING FOR YEARS BETTER STAFFING = BETTER CARE BUT WITHOUT THOSE RESEARCHERS CRUNCHING THE NUMBERS NO ONE EVER HEARS US.

B E T T E R

S T A F F I N G

=

B E T T E R

C A R E

There has never been a doubt.

[LadyFree28, BSN, LPN, RN]

Hospitals don't want to hear this though.

THIS..they keep putting their fingers in their ears while eventually shooting themselves in the foot...

[wooh, BSN, RN]

From the journal "No Shoot Sherlock"??

[LadyFree28, BSN, LPN, RN]

From the journal "No Shoot Sherlock"??

Hmmm....I saw it in the "Journal of Proven Bedside Nursing"...

[jfratian, DNP, RN, CRNA]

Allow me to play devil's advocate here for a minute. Clearly people would receive the best care if every med surg patient had their own nurse. However, there is a decreasing benefit with each nurse you add (i.e. concept of decreasing marginal utility), and therefore the 2nd nurse you add doesn't give you as much bang for your buck as the 1st (and the 2nd doesn't give you as much as the 3rd). If I had one patient on my floor, even if I did every little thing from education to ambulation, my day would be boring and empty.

Hospitals have to balance then benefit of extra nurses against the paycheck they have to pay them. Yes, you save money in terms of errors and accidents that nurses help avoid. However, there is a point where adding nurse #25 (for example) doesn't "pay for itself." In my experience, staff nurses always moan and groan about inadequate staffing regardless of the reality. We have 5 med surg patients to a nurse and I can think of several hospitals nearby where 6 or 7 is the norm.

I don't know what that perfect ratio is for acuity level "X" or "Y." My overall point is I bet the benefits of adding a nurse at...say Grady Memorial in Atlanta...is far for pronounced than adding one at Baylor (Heathcare Finance News 2009 best hospitals for nurses).

[Sippie]

Nurses have more time to actually teach with less patients. I'm not talking about one on one but say in Med Surg, you have 6-7 instead of 10 with no nurses aid or only one aid for 40 patients etc. (just an example) If patients actually understand their disease and can perform their own care properly, then they are less likely to have readmissions.

[herring_RN, ASN, BSN]

In 2002 an extensive study determined that for every additional more than four the odds of dying due to "failure to rescue' increased by 7% and each additional patient assigned to a nurse increased the odds of death.

Hospital Nurse Staffing and Patient Mortality

... Results After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue....

... Our results imply that had the patient-to-nurse ratio across all Pennsylvania hospitals been 4:1, possibly 4000 of these patients may have died, and had it been 8:1, more than 5000 of them may have died. While this difference of 1000 deaths in Pennsylvania hospitals across the 2 staffing scenarios is approximate, it represents a conservative estimate of preventable deaths attributable to nurse staffing in the state...

JAMA Network | JAMA | Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction