Hospital Nursing and 30-Day Readmissions Among Medicare Patients With Heart Failure, Acute Myocardial Infarction, and Pneumonia

Abstract

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; i.e. 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 (i.e., 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 one-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 (OR=1.07, [1.05–1.09]), 6% for pneumonia patients (OR=1.06, [1.03–1.09]), and 9% for myocardial infarction patients (OR=1.09, [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, [0.89–0.97]); 6% lower for myocardial infarction (OR = 0.94, [0.88–0.98]); and 10% lower for pneumonia (OR = 0.90, [0.85–0.96]) patients. Conclusions Improving nurses’ work environments and staffing may be effective interventions for preventing readmissions.

Nurse work environment and quality of care by unit types: A cross-sectional study

“…We found that better unit work environments were associated with superior quality of care, both the overall quality of care and care improvement. This finding is consistent with results in previous research Ma et al, 2014Ma et al, , 2015aMcHugh and Ma, 2013). In a hospital-level multi-country study, the researchers found that hospitals with poor hospital work environments had more nurses reporting poor quality of care, and this association was common across countries .…”

Contributing Factors to Hospital Readmissions

“…The nurse's educational background was not significantly associated with readmissions among patients with heart failure or myocardial infarction. However, for patients with an admitting diagnosis of pneumonia, there was a 3% lower risk of a 30-day readmission among hospitals for each 10% increase of hospital nurses with a BSN-level education (McHugh & Ma, 2013).…”

“…There is a relationship between hospital nurse staffing levels, work environment and nurse education levels and the 30-day readmission rates among Medicare patients (McHugh & Ma, 2013). The researchers studied patients between the ages of 65 and 89 who were readmitted with heart failure, myocardial infarction or pneumonia as their primary diagnosis.…”

Comparison of nurse staffing based on changes in unit-level workload associated with patient churn

“…Evidence is accumulating that higher nurse staffing is associated with better inpatient and post-discharge outcomes (Needleman et al 2011, Aiken et al 2012, McHugh & Ma 2013. When churn (i.e.…”