Each additional patient per nurse was associated with higher odds of 30-day readmission for heart failure (OR 1.07; 95% CI 1.05-1.09), pneumonia (OR 1.06), and myocardial infarction (OR 1.09).
Observational
Sí
Do better hospital nursing environments and staffing levels reduce 30-day readmissions in Medicare patients with heart failure, acute myocardial infarction, and pneumonia?
Better nurse work environments and lower patient-to-nurse ratios are associated with significantly lower 30-day readmission rates for Medicare patients with heart failure, myocardial infarction, and pneumonia.
Estimación del efecto: OR 1.07 (95% CI 1.05-1.09)
BACKGROUND: Provisions of the Affordable Care Act that increase hospitals' financial accountability for preventable readmissions have heightened interest in identifying system-level interventions to reduce readmissions. OBJECTIVES: To determine the relationship between hospital nursing; that is, nurse work environment, nurse staffing levels, and nurse education, and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. METHOD AND DESIGN: Analysis of linked data from California, New Jersey, and Pennsylvania that included information on the organization of hospital nursing (ie, work environment, patient-to-nurse ratios, and proportion of nurses holding a BSN degree) from a survey of nurses, as well as patient discharge data, and American Hospital Association Annual Survey data. Robust logistic regression was used to estimate the relationship between nursing factors and 30-day readmission. RESULTS: Nearly 1 quarter of heart failure index admissions 23.3% (n=39,954), 19.1% (n=12,131) of myocardial infarction admissions, and 17.8% (n=25,169) of pneumonia admissions were readmitted within 30 days. Each additional patient per nurse in the average nurse's workload was associated with a 7% higher odds of readmission for heart failure odds ratio (OR)=1.07; confidence interval CI, 1.05-1.09, 6% for pneumonia patients (OR=1.06; CI, 1.03-1.09), and 9% for myocardial infarction patients (OR=1.09; CI, 1.05-1.13). Care in a hospital with a good versus poor work environment was associated with odds of readmission that were 7% lower for heart failure (OR=0.93; CI, 0.89-0.97), 6% lower for myocardial infarction (OR=0.94; CI, 0.88-0.98), and 10% lower for pneumonia (OR=0.90; CI, 0.85-0.96) patients. CONCLUSIONS: Improving nurses' work environments and staffing may be effective interventions for preventing readmissions.
McHugh et al. (Tue,) conducted a observational in Heart failure, acute myocardial infarction, and pneumonia. Nurse staffing levels and work environment was evaluated on 30-day readmission for heart failure per additional patient per nurse (OR 1.07, 95% CI 1.05-1.09). Each additional patient per nurse was associated with higher odds of 30-day readmission for heart failure (OR 1.07; 95% CI 1.05-1.09), pneumonia (OR 1.06), and myocardial infarction (OR 1.09).