Nurses Working Overtime May Increase Post-Discharge Costs

More non-overtime nursing care improves discharge preparation and decreases ER use, costs

FRIDAY, May 20 (HealthDay News) -- Post-discharge readmission and emergency department (ED) utilization costs may be reduced by increasing registered nurses' (RNs') non-overtime hours and decreasing their overtime hours, according to a study published online April 21 in Health Services Research.

Marianne E. Weiss, D.N.Sc., R.N., from the Marquette University College of Nursing in Milwaukee, and colleagues analyzed data from 1,892 medical-surgical patients from 16 nursing units. The authors determined the impact of nursing unit staffing structure on the quality of discharge teaching, patient perception of discharge readiness, and readmissions and ED visits within 30 days of discharge, between January and July 2008. Patient and administrative data were collected from patient questionnaires before discharge, and monthly hours for RNs in hours-per-patient-day were obtained. Cross-hospital electronic searches identified 30-day readmission and ED use with reimbursement data.

The investigators found that higher RN non-overtime staffing directly decreased the chances of readmission (odd ratio [OR], 0.56), and indirectly reduced ED visits due to improved discharge teaching quality and patient discharge readiness. The likelihood of an ED visit increased with higher RN overtime staffing (OR, 1.70). One standard deviation increase in RN non-overtime hours and decrease in RN overtime hours would save an estimated $11.64 million and $544,000, respectively, from the 16 study units each year.

"This study extends previous health services research on the impact of nurse staffing on patient outcomes of hospitalization by linking the unit-level nurse staffing directly to post-discharge readmission and indirectly through discharge teaching process to patient readiness for discharge and subsequent ED visits," the authors write.

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