At the Intersection of Health, Health Care and Policy Cite this article as: Dragana Gough, Adam Higman and Jerzy Kaczor The Impact Of Nurse Staffing On Readmissions Health Affairs, 32, no.12 (2013):2225 doi: 10.1377/hlthaff.2013.1262
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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2013 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on March 16, 2015 at Queen Mary, University of London
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doi:
10.1377/hlthaff.2013.1262
The Impact Of Nurse Staffing On Readmissions Matthew McHugh and coauthors (Oct 2013) offer an interesting analysis of staffing ratios and their association with readmission rates. In our experience, nurses—who account for the largest share of the labor cost for health systems—are the most tightly controlled in terms of staffing levels. Although the connection offered by the authors between adequate staffing and outcomes is well supported in the article, the labor analysis and “apples to apples” matched pairing process raise a few questions. First, outcomes and readmission criteria are geared toward inpatient care delivery. Instead, McHugh and coauthors used adjusted patient days, a measure that includes a facility’s outpatient care. As a result, the authors may have created inaccurate comparisons of hospitals that offer varying degrees of outpatient services. Second, it is unclear if length-ofstay was taken into consideration during the matched pairing process. If it was not, the potential for pairing hospitals with very different care delivery models or service offerings (for example, psychiatry and geriatric care) would increase.
A third point to consider is that, based on data from the American Hospital Association for the years 2007 through 2011, there were shifts in the total numbers of inpatient days and registered nurse (RN) hours.1 According to the same source, there was an increase in RN hours between 2009 and 2011, but inpatient days decreased in the same time period. This means that hospitals on the whole have already been gradually increasing RN-patient ratios, while readmission rates largely remained the same. 2 This trend, which is not fully explainable by a reduction in licensed practical nurse hours, is another area that needs further research in light of the results in the study by McHugh and coauthors. Dragana Gough, Adam Higman, and Jerzy Kaczor Soyring Consulting ST . PETERSBURG , FLORIDA NOTES 1 American Hospital Association. AHA hospital statistics 2013: the comprehensive reference source for analysis and comparison of hospital trends. Chicago (IL): AHA; 2013. 2 Goodman DC, Fisher ES, Chang C-H (Dartmouth Institute for Health Policy and Clinical Practice). The revolving door: a report on U.S. hospital readmissions [Internet]. Princeton (NJ): Robert Wood Johnson Foundation; 2013 [cited 2013 Oct 29]. Available from: http://www.rwjf.org/ content/dam/farm/reports/reports/2013/ rwjf404178
Dece mber 2013
32:12
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Health Affa irs
2225
The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/32/12/2225.1.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2013 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on March 16, 2015 at Queen Mary, University of London
Letters There is a limit of 300 words for letters to the editor. Health Affairs reserves the right to edit all letters for clarity, length, and tone. Letters can be submitted by e-mail, [email protected], or the Health Affairs website, http:// www.healthaffairs.org.
doi:
10.1377/hlthaff.2013.1262
The Impact Of Nurse Staffing On Readmissions Matthew McHugh and coauthors (Oct 2013) offer an interesting analysis of staffing ratios and their association with readmission rates. In our experience, nurses—who account for the largest share of the labor cost for health systems—are the most tightly controlled in terms of staffing levels. Although the connection offered by the authors between adequate staffing and outcomes is well supported in the article, the labor analysis and “apples to apples” matched pairing process raise a few questions. First, outcomes and readmission criteria are geared toward inpatient care delivery. Instead, McHugh and coauthors used adjusted patient days, a measure that includes a facility’s outpatient care. As a result, the authors may have created inaccurate comparisons of hospitals that offer varying degrees of outpatient services. Second, it is unclear if length-ofstay was taken into consideration during the matched pairing process. If it was not, the potential for pairing hospitals with very different care delivery models or service offerings (for example, psychiatry and geriatric care) would increase.
A third point to consider is that, based on data from the American Hospital Association for the years 2007 through 2011, there were shifts in the total numbers of inpatient days and registered nurse (RN) hours.1 According to the same source, there was an increase in RN hours between 2009 and 2011, but inpatient days decreased in the same time period. This means that hospitals on the whole have already been gradually increasing RN-patient ratios, while readmission rates largely remained the same. 2 This trend, which is not fully explainable by a reduction in licensed practical nurse hours, is another area that needs further research in light of the results in the study by McHugh and coauthors. Dragana Gough, Adam Higman, and Jerzy Kaczor Soyring Consulting ST . PETERSBURG , FLORIDA NOTES 1 American Hospital Association. AHA hospital statistics 2013: the comprehensive reference source for analysis and comparison of hospital trends. Chicago (IL): AHA; 2013. 2 Goodman DC, Fisher ES, Chang C-H (Dartmouth Institute for Health Policy and Clinical Practice). The revolving door: a report on U.S. hospital readmissions [Internet]. Princeton (NJ): Robert Wood Johnson Foundation; 2013 [cited 2013 Oct 29]. Available from: http://www.rwjf.org/ content/dam/farm/reports/reports/2013/ rwjf404178
Dece mber 2013
32:12
Downloaded from content.healthaffairs.org by Health Affairs on March 16, 2015 at Queen Mary, University of London
Health Affa irs
2225
