News & Events

A New Study Finds that Nurses Staffing Levels Impact Readmissions for Pediatric Patients in Hospitals

05.09.2013

A New Study Finds that Nurses Staffing Levels Impact Readmissions for Pediatric Patients in Hospitals

Yet another study, the second in the last three weeks and one of dozens that have appeared in the last ten years , provides conclusive scientific evidence that reducing the patient load for nurses (also known as the patient-to-nurse ratio) dramatically improves care for patients, and reduces the  risk for a number of complications.  The most recent study (see details below) found that excessive patient assignments for nurses (anything above four patients per nurse) results in a significant increase in the risk for children being readmitted to the hospital due to inadequate care and patient education.  For children with medical conditions, every patient assigned to a nurse above four resulted in an 11 percent increased risk for readmission; and for children recovering from basic surgeries, each additional patient  assigned to a nurse increased the risk of readmission by a shocking 48%.  This study builds on earlier research published in JAMA for adult patients, which found that for every patient assigned to a nurse above the recommended four patients resulted in a 7 percent increase in the risk of death for those patients.  A study we circulated last week found that safer RN staffing levels improved care for patients experiencing heart failure. 

This study, as noted in the article below, provides strong scientific support for legislation filed in Massachusetts and many other states that would require hospitals to set safe limits on nurses’ patient assignments.  The push for safe staffing legislation to protect patients has grown as more and more hospitals have cut RN staffing and increased nurses’ patient assignments for nurses in the wake of state and national health care reform, and as the  hospital industry continues to merge into major corporate networks, many of them for-profit, with the ultimate focus on boosting profit margins at the expense of patient safety.  Just last month, nurses at Steward Quincy Medical Center conducted a one-day strike over their concerns for patient safety due to deplorable staffing conditions, and nurses at Steward Merrimack Valley Hospital and Steward Holy Family Hospital held rallies to protest dangerous staffing conditions.  This 2,000 nurses at UMass Medical Center in Worcester are considering their own one-day strike to protest dangerous staffing levels at the that Level One Trauma Center, where management is demanding the right to assign nurses, including nurses who care for pediatric patients, up to seven patients at one time. 

For comment on these studies and these issues, contact  David Schildmeier at the MNA and we will  arrange an interview with a nurse in your area.  781-249-0430, dschildmeier@mnarn.org.
 

http://www.fiercehealthcare.com/story/nursing-staff-ratios-directly-impact-pediatric-hospital-readmissions/2013-05-08?utm_campaign=AddThis&utm_medium=AddThis&utm_source=email#.UYspNlc6kRk.email

Nursing staff ratios directly impact pediatric hospital readmissions
Study examined common medical and surgical conditoins

May 8, 2013 | By Ilene MacDonald

There is a direct link between nursing staff ratios and hospital readmissions for children with common medical and surgical conditions, according to a new study in the online journal BMJ Quality and Safety in Health Care.

The study, led by a nurse scientist at Cincinnati Children's Hospital Medical Center, is believed to be the first of its kind to examine the extent to which hospital nurse staffing levels are related to pediatric readmissions. The study examined common medical and surgical conditions, such as pneumonia and appendectomy, and pediatric readmissions.

The publication of the study comes in the wake of the introduction last month of proposed federal legislation mandating nursing staffing ratios across the country.

The study found that an increase of only one patient in a hospital's average staffing ratio raised the likelihood of a medical patient's readmission within 15-30 days by 11 percent. But the odds of readmission for surgical patients increased by 48 percent.

Children treated in hospitals meeting a staffing benchmark of no more than four patients per nurse were significantly less likely to be readmitted within 15-30 days. Nursing staffing ratios had no effect on readmissions within the first 14 days after discharge.

The study team looked at the outcomes of more than 90,000 children in 225 hospitals using survey and discharge data from California, Florida, New Jersey and Pennsylvania, as well as the American Hospital Association Annual Survey from these four states, according to a statement published by EurekAlert. All hospitals included in the study were non-federal, acute-care facilities with at least 50 pediatric discharges a year.

"Lower patient-to-nurse ratios hold promise for reducing preventable readmissions by allowing for more effective pre-discharge monitoring of patient conditions, improving discharge preparation and through enhanced quality improvement success," Heather Tubbs-Cooley, Ph.D., a nurse scientist at Cincinnati Children's and the study's main author, said in the statement.

"Delivering high quality patient care requires nurses' time and attention, and better staffing conditions likely allow nurses to thoroughly complete the clinical care that children and their families need in order to have a successful discharge," she added.

Despite the study results, Tubbs-Cooley isn't jumping on the bandwagon for mandated staffing ratios. "We have abundant evidence that better nurse staffing levels in hospitals are associated with better patient outcomes, but we lack robust data to guide decision-making regarding optimal staffing levels for a given unit or patient population," she said.

In order to obtain that data, Tubbs-Cooley plans to test different research designs and methods than those the industry has relied on in the past.

 


Contact: Jim Feuer
jim.feuer@cchmc.org
513-636-4656

Cincinnati Children's Hospital Medical Center

Nurse staffing ratios affect hospital readmissions for children with common conditions

A new study shows that pediatric nurse staffing ratios are significantly associated with hospital readmission for children with common medical and surgical conditions.

The study, led by a nurse scientist at Cincinnati Children's Hospital Medical Center, is believed to be the first to examine the extent to which hospital nurse staffing levels are related to pediatric readmissions. Publication of the study comes just weeks after the introduction of federal legislation that would mandate nurse staffing ratios across the country.

The study, published online in the journal BMJ Quality and Safety in Health Care, looked at such common medical and surgical conditions as pneumonia and appendectomy.

"Preventing unnecessary hospital readmissions is an increasingly important focus of large-scale quality improvement initiatives," says Heather Tubbs-Cooley, PhD, RN, a nurse scientist at Cincinnati Children's and the study's main author. "Reducing preventable readmissions is also a high priority for hospitals, particularly as they face the prospect of nonpayment for these services."

Dr. Tubbs-Cooley and colleagues from the University of Pennsylvania found that each one patient increase in a hospital's average staffing ratio increased the odds of a medical patient's readmission within 15-30 days by 11 percent. The odds of readmission for surgical patients increased by 48 percent.

Children treated in hospitals meeting a contemporary staffing benchmark of no more than four patients per nurse were significantly less likely to be readmitted within 15-30 days. Nursing staffing ratios had no effect on readmissions within the first 14 days after discharge.

The study team examined the outcomes of more than 90,000 children in 225 hospitals using survey and discharge data from California, Florida, New Jersey and Pennsylvania, as well as the American Hospital Association Annual Survey from these four states. All hospitals included in the study were non-federal, acute-care facilities with at least 50 pediatric discharges a year.

"Lower patient-to-nurse ratios hold promise for reducing preventable readmissions by allowing for more effective pre-discharge monitoring of patient conditions, improving discharge preparation and through enhanced quality improvement success," says Dr. Tubbs-Cooley. "Delivering high quality patient care requires nurses' time and attention, and better staffing conditions likely allow nurses to thoroughly complete the clinical care that children and their families need in order to have a successful discharge."

Despite the study results, she isn't ready just yet to endorse mandated staffing ratios. "We have abundant evidence that better nurse staffing levels in hospitals are associated with better patient outcomes, but we lack robust data to guide decision-making regarding optimal staffing levels for a given unit or patient population. Producing that evidence will require different designs and methods than those we have relied on in the past."

Dr. Tubbs-Cooley plans to test these research designs in further studies.