With ever-increasing cost constraints, healthcare executives are being forced to make deeper and deeper budget cuts. Because labor is such a large expense, it’s often an area that’s targeted for reductions. However, cutting labor expenses by reducing staffing levels can be ineffective in the long run. In fact, inadequate staffing levels can have far-reaching effects for hospitals and the patients they serve.
After many hospitalizations with my daughter, we’ve learned that discharge planning is one of the most important parts of a hospital stay. Everything needs to be aligned just right for a successful discharge, and it takes a lot of care coordination so that a readmission can be avoided. As a family, we start thinking ahead to discharge day as soon as my daughter is admitted, and we’re always happy when the medical team is on the same page.
When patients aren’t able to receive the care or discharge planning they require the first time around because of low staffing levels, they have a greater risk of being readmitted to the hospital within 30 days. That results in higher costs and increased readmission penalties. In fact, according to an article in HealthLeaders Media’s November 2013 issue, reducing readmissions is the top challenge of 23 percent of medium-sized hospitals.
Staffing correctly requires a delicate balance. Overstaffing incurs unnecessary expenses and understaffing impacts patient outcomes. However, finding the ‘right-staffing’ level is challenging, and it requires matching patients and caregivers based on patient needs and caregiver competencies. Patient acuity and classification tools help hospital decision-makers improve their patient outcomes by optimizing nurses’ patient assignments.
Industry leaders are taking big steps forward with matching patients with the optimal caregivers. For example, the Health Leaders article profiled Memorial Hermann Health System in Houston, showing how they have combated readmissions by expanding the reach of care management. Staff were matched with the right high-risk patients, and care managers were able to create a care plan for these patients who had an increased risk of being readmitted to the health system.
The link between nurse-patient ratios and readmission rates
Common sense tells us that strategies such as patient education, care coordination and discharge planning can help reduce readmissions. Yet, when there aren’t enough nurses, these strategies can fall to the wayside, having a negative impact on readmissions.
The research backs this up. A recent study in Health Affairs found that hospitals with higher nurse staffing were 25 percent less likely to be penalized for hospital readmissions within 30 days than otherwise similar hospitals with lower staffing. Lead author Matthew D. McHugh, associate professor of nursing at the Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, and a senior fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania, in Philadelphia and his team analyzed data from the Center for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program (HRRP) for fiscal year 2013 to identify HRRP penalties at 2,976 adult, non-federal and acute care hospitals. Researchers used a matching approach to carry out an “apples to apples” comparison of HRRP penalties between well-staffed hospitals and otherwise similar hospitals with lower staffing levels.
Staffing levels have a similar impact in the pediatric environment. According to a new study by the Cincinnati Children’s Hospital Medical Center, hospitals with a nurse-patient ratio of 1 to 4 were less likely to be readmitted within 15 to 30 days than those hospitals with higher nurse-patient ratios. According to the study, when health systems increase their nurse-patient ratios by 1, or when each nurse is given one more patient, the readmission rate rises by 11 percent. Researchers reviewed data collected from more than 90,000 children in 225 hospitals across the nation to determine if low nurse-patient ratios are detrimental to patient health and contribute to high readmission rates.
“Lower patient-to-nurse ratios hold promise for reducing preventable readmissions by allowing for more effective predischarge monitoring of patient conditions, improving discharge preparation and through enhanced quality improvement success,” said Heather Tubbs-Cooley, a nurse scientist at Cincinnati Children’s Hospital and lead author of the study. “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.”
Both common sense and the evidence reinforce that focusing on staffing levels is worth the effort because it ensures that patients receive the care they need to avoid preventable readmissions. While optimal staffing levels can be difficult to achieve, developing the ability to right-staff consistently and effectively makes sense from both a patient care and financial aspect.
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