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Study: Increased nurse staffing decreases costs

More registered nurses working non-overtime hours in a hospital unit results in fewer patient readmissions after discharge, according to a study published in the current issue of Health Services Research.

For the study, titled "Quality and Cost Analysis of Nurse Staffing, Discharge Preparation, and Postdischarge Utilization," researchers examined patient questionnaires, electronic medical records and administrative data for 1,892 patients in 16 nursing units in four acute care hospitals in one Midwestern healthcare system.

According to the study, when RN non-overtime staffing was higher, discharged patients were less likely to be readmitted; when RN overtime staffing was higher, patients were more likely to be readmitted to the emergency room following discharge.

[See also: Studies show higher nurse staffing levels benefit patients.]

More nursing staff hours allowed nurses to have more time to do core functions, including instructing patients more thoroughly on self-management care after discharge. When patients have a better understanding of post-discharge care, they are less likely to be readmitted. More overtime hours may lead to suboptimal performance because of extended work situations.

"Any time you're talking about readmission and ED visits you're talking about cost issues," said Marianne Weiss, RN, an associate professor at the College of Nursing at Marquette University and one of the study's lead investigators. "Any time you talk about staffing, you're talking about cost issues."

The study's cost-benefit analysis found that increasing non-overtime nursing staff hours would result in an estimated net savings of $409.59 per hospitalized patient. By reducing non-overtime nursing staff hours .75 hours per patient per day, hospitals would lose $197.92 per patient (a sum of RN staffing costs of $145.74 and $52.18 in lost revenue from reduced readmissions) but payers would save $607.51 per patient due to reduced post-discharge use.

The cost-benefit analysis also found that decreasing overtime nursing hours would result in an estimated net savings of $19.16 per hospitalized patient. By reducing RN overtime staffing by .07 hours per patient per day, hospitals would save $8.18 per patient, derived by offsetting reduced revenue from emergency department visits with reduced overtime salary costs. Payers would save $10.98 per patient due to reduced ED visits.

"If somebody isn't readmitted to the hospital, the benefit right now is to the payer and the patient," said Weiss. "But can you get to that benefit if you don't incur some additional costs on the front end? Because if you're going to increase some staffing to achieve an end point, then how do you pay for that, and so that's sort of the notion of can you take some of those savings and reinvest them?"

"You're not necessarily using up all the savings to invest in the front end," she continued. "The net is very much positive, but we don't have structures in place to deal with that now."

"We want to get into models where there is benefit to quality and benefit on the cost side," she said. The accountable care models the healthcare system is moving into may offer those benefits, but, she pointed out, "the devil is in the details."

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