Study Shows Nursing Staff, Environment Reduces Readmissions

PHILADELPHIA — New provisions to the Affordable Care Act (ACA) penalize hospitals for an excess amount of preventable hospital readmissions, which cost Medicare more than $15 billion every year. However, in January, a study published in Medical Care says that improving nurses’ work environment can help reduce that number.

Led by Matthew McHugh, PhD, assistant professor at the University of Pennsylvania School of Nursing, the study found that increased nursing-to-patient staffing ratios and a good work environment for nurses could help reduce 30-day readmission rates for Medicare patients with heart failure, myocardial infarction and pneumonia.

The research team analyzed data from a cross-sectional survey of 20,000 registered nurses working at 210 hospitals in California, New Jersey and Pennsylvania, which questioned them about hospital work environment, nurse staffing levels and educational attainment. It also used data about hospitals’ structural characteristics, ownership, teaching status and size from the American Hospital Association Annual Survey and data on admissions and readmissions of patients between the age of 65 and 89 years old from state discharge abstract databases.

In compliance with the ACA, the Centers for Medicare and Medicaid Services will reduce payments to hospitals that have higher than normal readmission rates for patients with heart failure, acute myocardial infarction and pneumonia, which is why the team decided to focus on these three diseases.

After factoring in patient and hospital characteristics, the research revealed that nurse staffing levels and nurses’ work environment had a significant impact on readmission numbers for patients being treated for one of the three diseases. Plus, the percentage of nurses with baccalaureate degrees in nursing also had a significant effect on readmissions for patients with pneumonia specifically.

“Our findings indicate that improving nurses’ work environments and reducing their workloads can reduce readmissions for Medicare patients with common conditions,” McHugh said in a statement. “It is certainly worthwhile for hospital administrators to examine these two factors and explore whether they can be optimized to improve patient outcomes and reduce admissions.”

Each additional patient per nurse added to an average nurse’s workload had 7 percent higher odds of readmission for heart failure patients, 6 percent higher for pneumonia patients and 9 percent higher for myocardial infarction patients within 30 days of being discharged. Care in hospitals with good versus poor work environments for nurses had 7 percent lower odds of 30-day readmission for heart failure patients, 6 percent lower for myocardial infarction patients and 10 percent lower for pneumonia patients.

For those nurses that worked in hospitals with good work environments, 59 percent said they were confident that their patients could manage on their own when discharged, versus 48 percent.

The Princeton, N.J.-based Robert Wood Johnson Foundation Nurse Faculty Scholars program provided funding for the study.