Two Recent Studies Reveal Factors Leading to Readmissions

Hospitals with more nurse staffing were 25 percent less likely to be penalized at all than hospitals with less staffing, and 41 percent less likely to receive the maximum penalty, a recent study suggests.

Nurse managers creating effective patient care plans is critical in reducing hospitals readmissions. Recent research suggests increased hours of nursing care results in decreased readmissions, which most facilities agree is preventable. An online master’s degree in nursing may help nurses develop these plans, become a leader and improve care for their patients.

As hospitals everywhere are striving to reduce the number of preventable readmissions, researchers are supporting their efforts by identifying factors that may cause patients to end up right back in the hospital. The resulting information may be helpful to nurses who create patient care plans, nurse managers who determine staffing ratios, or to nurse case managers who coordinate discharge planning.

Higher Nurse Staffing is Linked to Reduced Readmission Penalties

The study: Conducted by the University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, and published in the October 2013 issue of Health Affairs.

The methodology: Researchers examined nurse staffing levels and readmission penalties at 2,826 hospitals. They obtained penalty data from the Centers for Medicare and Medicaid Services (CMS) and staffing data from the 2009 American Hospital Association Annual Survey. The researchers paired hospitals with similar characteristics, so that they were comparing hospitals that were alike in every way except nurse staffing levels. The staffing measure they used was not a ratio of nurses to patients, but rather the number of nursing hours per patient day.

The conclusions: More hours of nursing care results in less likelihood of a readmission rate that’s high enough to incur a penalty. When compared to the lowest performing hospitals, the best performers had an extra three hours of nursing care per patient per day.

Specifically, the researchers found:

  • Hospitals with more nurse staffing were 25 percent less likely to be penalized at all than hospitals with less staffing, and 41 percent less likely to receive the maximum penalty.
  • Each additional nurse hour per patient day resulted in a 10 percent drop in the odds of receiving penalties for unacceptable readmission rates.

The study helps to build a business case for improving nurse staffing. It’s not clear why more nursing care equates to lower readmissions, but perhaps patients are discharged with better instructions for self-care, or less stressed by the hospital experience.

Patients with “Post-Hospital Syndrome” Are Readmitted More Frequently

The study: Long-Term Cognitive Impairment after Critical Illness, published in the New England Journal of Medicine, Oct. 3, 2013. A supporting article appeared in the NEJM earlier this year: Post-Hospital Syndrome — An Acquired, Transient Condition of Generalized Risk.

The methodology: Researchers tracked patients in the ICU, evaluating them for in-hospital delirium and assessing their cognitive functions at three and 12 months after discharge.

The conclusions: A whopping 74 percent of the patients tracked experienced delirium after being hospitalized. Three months after they were discharged, 40 percent had cognition scores that were lower than expected and comparable to the scores of patients with traumatic brain injury. These patients had an impaired ability to plan, think, or organize and the effect could linger up to a year after discharge.

In the related commentary, cardiologist Harlan Krumholz called this effect “post-hospital syndrome” and explained that discharged patients are at greater risk for a wide range of adverse health events, due to the physiological stress of being hospitalized. Hospitalized patients can become weak and vulnerable from lack of exercise, sleep deprivation, inadequate nutrition, information overload, medication side effects and general hospital chaos. Patients who are heavily sedated can become especially disoriented and confused.

Krumholz calls for a more holistic approach to treatment and discharge planning. In his examination of the issue, he writes:

At a minimum, we should assess a patient’s condition at discharge by soliciting details far beyond those related to the initial illness. As we determine readiness for transition from the inpatient setting, we should be aware of functional disabilities, both cognitive and physical, and align care and support appropriately. We should also use risk-mitigation strategies that stretch beyond the cause of the initial hospitalization and seek to prevent infections, metabolic disorders, falls, trauma, and the gamut of events that commonly occur during this period of generalized risk.


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