Quality and Cost Analysis of Nurse Staffing, Discharge Preparation, and Postdischarge Utilization

The cost of hospital readmission within 30 days of discharge has been estimated to exceed $17 billion annually. Could changes to nursing unit staffing and to discharge teaching improve patient outcomes and help cut down on costly readmissions?

Researchers analyzed patient questionnaires, electronic medical records and administrative data for 1,892 medical-surgical patients in 16 nursing units of four hospitals in 2008.

Overall, patients rated the quality of discharge teaching high (7.8 out of 10) and of sufficient quantity (5 out of 10). The 30-day readmission rate was 12 percent; plus 5 percent for emergency department (ED) visits without readmission.

Analysis further revealed that readmission rates were lower when nursing units had higher RN nonovertime staffing. When RN overtime staffing was higher, so were the odds of ED use. An increase in RN nonovertime staffing was significantly associated with higher quality discharge teaching. Higher patient discharge readiness scores were associated with lower odds of an ED visit.

Increasing RN nonovertime staffing costs hospitals $197.92 per patient and saves payers $607.51 per patient in reduced postdischarge utilization. Hospitals, however, do not have a business case to bear the costs of improved hospital RN staffing without payment reforms, such as bundling of payments for hospital and post-hospital care.