Key result
Each additional patient per nurse increased 30-day readmission odds by 8%, while the best work environments lowered 30-day readmission odds by 12% following elective joint replacement.
Why the study?
Do nurse staffing levels and work environment quality affect unplanned readmissions in Medicare patients following elective total hip and knee replacement?
Cross-Sectional (n=112,017)
Yes
Do nurse staffing levels and work environment quality affect unplanned readmissions in Medicare patients following elective total hip and knee replacement?
Higher nurse staffing levels and better work environments are associated with lower odds of 10- and 30-day unplanned readmissions following elective total hip and knee replacement in older adults.
Answers are grounded in this paper and cite their sources.
Better nurse staffing and environments may lower readmission risk after joint replacement; leaves open whether interventions can achieve these associations.
OBJECTIVE: To examine the effect of nurse staffing and the work environment on 10- and 30-day unplanned readmissions for US Medicare patients following elective total hip and knee replacement. DESIGN: A cross-sectional analysis of secondary data. SETTING: Acute care hospitals in California, Florida, New Jersey and Pennsylvania, during 2006. PARTICIPANTS: Medicare patients (n = 112 017) admitted to an acute care hospital for an elective total hip or knee replacement. MAIN OUTCOME MEASURES: The adjusted odds ratio (OR) of experiencing an unplanned readmission within 10 and 30 days of discharge following an elective total hip or knee replacement. RESULTS: Our sample included 112 017 Medicare patients in 495 hospitals. Nearly 6% of the patients were readmitted within 30 days; more than half of whom were rehospitalized within 10 days. Adjusted for patient and hospital characteristics, patients had 8% higher odds of 30-day readmission and 12% higher odds of 10-day readmission, for each additional patient per nurse. Patients cared for in the best work environments had 12% lower odds of 30-day readmission. CONCLUSIONS: Readmission outcomes following major joint replacement are associated with hospital nursing care. Attention to nurse work conditions may be central to improving readmissions in this postoperative Medicare population.
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Lasater et al. (2016) conducted a cross-sectional in Elective total hip or knee replacement (n=112,017). Higher patient-to-nurse ratio and poorer work environment vs. Lower patient-to-nurse ratio and better work environment was evaluated on Unplanned readmission within 10 and 30 days of discharge (OR 1.08). Each additional patient per nurse increased 30-day readmission odds by 8%, while the best work environments lowered 30-day readmission odds by 12% following elective joint replacement.
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