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Shrink Readmissions by Adding Nurses

Philip Betbeze, for HealthLeaders Media, October 11, 2013

Bumping up nurse staffing levels by three nurse hours per patient day provides a demonstrable and marked reduction in hospital readmissions. But the financial implications of doing so are tricky.

Changing the business model in healthcare from payment for outcomes rather than for volume of services rendered is critical to reducing costs and improving quality in healthcare. But so far, the financial incentives for re-engineering the business model are not significant enough to force a rapid transition.


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Readmissions 'Drop Like a Rock' with Predictive Modeling


Still, we may be heading in the right direction—for instance, in nurse staffing.

Nurse staffing levels are always a critical point of contention between staff and management. CEOs rightly keep a close eye on labor costs, and nurses are among the most expensive of hospital labor. States, labor unions, and others have attempted to tell CEOs how they should manage nurse staffing ratios, and in many circumstances, they have succeeded in establishing minimum levels.

But how much is enough?

Nurse staffing ratios have been studied backwards and forwards to determine their impact on patient care, but a recent study in Health Affairs has finally linked nurse staffing levels to outcomes. According to lead researcher Matthew McHugh, PhD, JD, MPH, RN, hospitals with higher nurse-to-patient staffing ratios have lower odds for being penalized for excessive readmissions in CMS's Hospital Readmissions Reduction Program, which is estimated to reduce hospital payments by roughly $280 million in 2013.

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1 comments on "Shrink Readmissions by Adding Nurses"


Phyllis Kritek (10/14/2013 at 3:37 PM)
Thank you for covering this studies methodology, analysis and outcomes. I would observe that Aiken, et al demonstrated that the average cut in nursing personnel in acute care in the 90s was 9%. We concurrently cut LOS dramatically, so we had far fewer nurses caring for far more seriously ill patients. Not surprisingly, the IOM announced we had serious drug errors (To Err is Human) and that apparently patient safety was related to nursing care (Keeping Patients Safe).During longer LOSs nurses were able to do continuity of care, patient education, family education and case management. We eliminated it. We discovered this was a bad idea. Now we are trying to reinvent the wheel. The answer to this issue was available in the 90s however the apparent invisibility of nursing care created this problem. This study is best understood as a part of the history of health care in the US.