Examining the Impact and Value of Nursing Practices to Reduce Re-Hospitalizations

Research briefs from the Robert Wood Johnson Foundation (RWJF) Nursing Research Network identify specific ways nurses affect patient care quality and outcomes. Since 2005, the Interdisciplinary Nursing Quality Research Initiative (INQRI) program has supported interdisciplinary teams that involved nursing scholars and scholars from other disciplines in research projects—from the conceptual study design to the adoption in practice of new measures of standards of care.

This research brief determines the relationships between unit-level nurse staffing, quality of discharge teaching, readiness for hospital discharge, and rates of emergency department (ED) visits and re-hospitalizations in the first 30 days after hospital discharge; and to estimate the cost-benefit of investing in nurse staffing to improve patient outcomes.

Key Findings

  • Higher non-overtime RN hours per patient day [RNHPPD] were associated with decreased likelihood of re-hospitalization within 30 days post-discharge.

  • Higher overtime RNHPPD were associated with increased likelihood of an ED visit.

  • Higher non-overtime RN staffing was indirectly associated with increased likelihood of an ED visit.

  • Investments in increased RNHPPD could produce substantial potential savings from reduced post-discharge utilization costs.

  • The study findings support these recommendations: monitor and manage unit-level nurse staffing to minimize re-hospitalizations and ED use after hospital discharge; assess quality of discharge teaching and readiness standard practices within hospital discharge preparation processes; and realign payment incentives to offset the costs of increasing nurse staffing, avoiding costs through improved post-discharge utilization.

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To support interdisciplinary studies that address critical knowledge gaps regarding causal linkages between nursing and health care quality and to synthesize, translate, and disseminate major findings to key stakeholders.

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