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Nurse staffing levels key to cutting readmissions after surgery

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Patients are more likely to require readmission after undergoing elective hip and knee surgery in hospitals with inadequate nurse staffing and poor nurse work environments, warn US researchers.

The authors of the study, by the highly respect University of Pennsylvania school of nursing, point to hospital nurses as a likely answer to the need for reducing postoperative readmissions.

“This study supports the notion that hospital nurses are fundamental to ensuring high quality care”

Karen Lasater

The research, published in the International Journal for Quality in Health Care, was based on data from 112,000 patients in nearly 500 US hospitals.

Nearly 6% of the patients were readmitted within 30 days – most within 10 days – after elective total hip or knee replacement.

Accounting for different patient and hospital characteristics, the researchers found every additional patient in a nurse’s workload was associated with an 8% increased likelihood of a patient being readmitted within 30 days of discharge after surgery.

Patients who underwent surgery in hospitals where nurses reporting having supportive environments, including strong professional relationships with doctors and autonomy in clinical practice, were 12% less likely to be readmitted.

University of Pennsylvania school of nursing

Nurse staffing levels key to cutting readmissions after surgery

Matthew McHugh

The most common reason patients were readmitted was for post-operative infection, which the study authors highlighted was strongly linked to quality of nursing care.

Senior author Matthew McHugh said: “These study findings are consistent with decades of prior research demonstrating the role hospital nurses play in ensuring safe outcomes for surgical patients.

“Nurses work around-the-clock providing care to patients before, during, and after surgery, making them the likely healthcare providers to identify and intervene on early warning signs that could lead to a negative health outcome,” he added.

Fellow author Dr Karen Lasater said: “This study supports the notion that hospital nurses are fundamental to ensuring high quality care and outcomes for patients.”

It follows a recent study by researchers from the same nursing school that found hospitals with better nurse staffing levels and care environments – as recognised under the Magnet accreditation scheme – were associated with lower mortality after surgery, especially for higher risk patients.

As reported by Nursing Times earlier this month, the analysis focused on 25,752 patients having surgery in 328 hospitals.

Those undergoing general procedures at hospitals with “better nursing environments generally receive care of higher value”, said the researchers in the journal JAMA Surgery.

Meanwhile, a separate group of researchers have said a simple risk scoring method has the potential to easily identify hospital patients in need of more intensive transitional care to reduce avoidable readmissions.

The authors of the international study, published in JAMA Internal Medicine, found that the HOSPITAL score, based on an acronym of comprising clinical variables linked, successfully predicted patients at high risk of a 30-day potentially avoidable readmission.

The latest study was supported by grants from the US National Institute of Nursing Research and from the Robert Wood Johnson Foundation Nurse Faculty Scholars Program.

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