Nursing impact on 30-day re-admission

This post is part of “The Nursing Ideas Challenge” a call for nurses to commit setting aside time to learn and to share what they have learned.

The Article:

Hospital nursing and 30-day readmission among medicare patients with heart failure, acute myocardial infarction, and pneumonia

Big Idea:

Generally a health work enivonrment, lower nure patient ratios and more educated nurses are expected to improve care. This paper looks at the evidence of how the hospital environment (workplace culture, patient-to-nurse-ratio, and proportion of nurses with a BSN) effect patient care.

Evidence: The authors used data from California, New Jursey and Pennsylvania, which collect outcomes measure on patient with heart failure, acute myocardial infarction and pneumonia. This data was paired with mailed out surveys to nurses (>78,000 were completed), and the information was matched to their organizations (California=210, Pennsylvania=134, New Jersey=68).

Quotable:

Preventable hospital readimmission costs Medicare $15 Billion annually.

Only 52% of hospital staff were confident their patients could manage their own care when discharged.

This table or reasons for readmission was interesting to look at:

McHugh MD Ma C Top Reasons for Reamission

So What?

This research is an important piece to add to the pile supporting the savings that nurses make. Investing in the  nursing work environment could provide measurable impact for the healthcare system. As nurses we need to be aware of this evidence and use it at the table when discussion of changing nursing staff ratios or making the case for investing in workplace improvements for staff.

http://www.ncbi.nlm.nih.gov/pubmed/23151591

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One Response to “Nursing impact on 30-day re-admission”

  1. Drew Ster
    December 24, 2015 at 12:22 pm #

    As I continue to get more experience with being a nurse, I have begun to kick around the bigger issues within nursing….including this one. I know that reducing the chances of readmissions is an important goal, but I am not convinced that it’s an achieveable one.

    I have lost count of the number of patients, even with many resources, who are not interested in complying with diets, medicine intake, or any other health restrictions to help manage their health. For example, I have worked with diabetics who feel it is more important to eat and drink anything, at will. They get angry when they are denied what they want, even if it has deadly consequences. Of course, it gets even more disheartening when those patients also receive surveys about consumer satisfaction about their visit… which have a direct bearing on reimbursement.

    Also, there is another issue that can be out of the reach of hospital staff when it comes to patient post-hospital compliance. I have worked with patients who may have friends/family in their lives, but not with enough resources to help look out for/advocate/support the patient. These patients may not qualify for going into a nursing home or assisted living, but the going home option is all that is available. Without someone to help manage their resources, those patients end up back in the system.

    I am not entirely convinced that studies like this capture this data, nor does the government necessarily take it into consideration. The penalties become as non-nonsensical as ZERO TOLERANCE policies. There are always exceptions to the rule with anything. Subsequently, I have no idea what a fix for these issues may be.

    -Drew (Night Shift RN in an LTACH)

    p.s. Interesting blog with thought-provoking posts!

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