Nurse staffing ratios affect hospital readmissions for children with common conditions

May 8, 2013

A new study shows that pediatric nurse staffing ratios are significantly associated with hospital readmission for children with common medical and surgical conditions.

The study, led by a nurse scientist at Cincinnati Children's Medical Center, is believed to be the first to examine the extent to which hospital nurse staffing levels are related to pediatric readmissions. Publication of the study comes just weeks after the introduction of that would mandate nurse staffing ratios across the country.

The study, published online in the journal BMJ Quality and Safety in Health Care, looked at such common medical and surgical conditions as pneumonia and appendectomy.

"Preventing unnecessary hospital readmissions is an increasingly important focus of large-scale quality improvement initiatives," says Heather Tubbs-Cooley, PhD, RN, a nurse scientist at Cincinnati Children's and the study's main author. "Reducing preventable readmissions is also a high priority for hospitals, particularly as they face the prospect of nonpayment for these services."

Dr. Tubbs-Cooley and colleagues from the University of Pennsylvania found that each one patient increase in a hospital's average staffing ratio increased the odds of a medical patient's within 15-30 days by 11 percent. The odds of readmission for increased by 48 percent.

Children treated in hospitals meeting a contemporary staffing benchmark of no more than four patients per nurse were significantly less likely to be readmitted within 15-30 days. Nursing staffing ratios had no effect on readmissions within the first 14 days after discharge.

The study team examined the outcomes of more than 90,000 children in 225 hospitals using survey and discharge data from California, Florida, New Jersey and Pennsylvania, as well as the American Hospital Association Annual Survey from these four states. All hospitals included in the study were non-federal, acute-care facilities with at least 50 pediatric discharges a year.

"Lower patient-to-nurse ratios hold promise for reducing preventable readmissions by allowing for more effective pre-discharge monitoring of patient conditions, improving discharge preparation and through enhanced quality improvement success," says Dr. Tubbs-Cooley. "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."

Despite the study results, she isn't ready just yet to endorse mandated staffing ratios. "We have abundant evidence that better levels in hospitals are associated with better patient outcomes, but we lack robust data to guide decision-making regarding optimal staffing levels for a given unit or patient population. Producing that evidence will require different designs and methods than those we have relied on in the past."

Dr. Tubbs-Cooley plans to test these research designs in further studies.

Explore further: California nurse staffing

Related Stories

California nurse staffing

July 15, 2011
In a comprehensive analysis comparing nurse staffing in California hospitals to similar hospitals in the U.S. over nearly a decade, researchers at the University of Pennsylvania School of Nursing have found that controversial ...

Improved staffing cuts medicare patient readmissions

January 4, 2013
(HealthDay)—Hospital nurses with good work environments who are caring for fewer patients have significantly fewer elderly Medicare patients with heart failure, acute myocardial infarction (MI), and pneumonia who are readmitted ...

More nurses for hospital patients: Impact on quality questionable

September 12, 2012
Passage of a bill in 1999 requiring minimum nurse-to-patient ratios in California hospitals increased the number of nurses but resulted in mixed quality of care, according to a new study in the journal Health Services Research.

RN staffing affects patient success after discharge

April 26, 2011
Higher non-overtime staffing levels of registered nurses lower the probability of patient readmissions to the hospital, a new study finds. However, higher levels of RN overtime increase the likelihood of unplanned visits ...

New study reveals increasing nurse-to-patient ratios do not extend patient safety

February 27, 2012
(Medical Xpress) -- Hospitals are currently under pressure to control the cost of medical care, while at the same time improving patient health and reducing medical errors through appropriate nurse staffing levels. A study ...

Magnet hospitals achieve lower mortality, report says

April 16, 2013
Lower mortality and other improved patient outcomes achieved at designated "Magnet hospitals" are explained partly—but not completely—by better nurse staffing, education, and work environment, reports a study in the May ...

Recommended for you

Brain disease seen in most football players in large report

July 25, 2017
Research on 202 former football players found evidence of a brain disease linked to repeated head blows in nearly all of them, from athletes in the National Football League, college and even high school.

Safety of medical devices not often evaluated by sex, age, or race

July 25, 2017
Researchers at Yale and the University of California-San Francisco have found that few medical devices are analyzed to consider the influence of their users' sex, age, or race on safety and effectiveness.

Why you should consider more than looks when choosing a fitness tracker

July 25, 2017
A UNSW study of five popular physical activity monitors, including Fitbit and Jawbone models, has found their accuracy differs with the speed of activity, and where they are worn.

Dog walking could be key to ensuring activity in later life

July 24, 2017
A new study has shown that regularly walking a dog boosts levels of physical activity in older people, especially during the winter.

Alcohol to claim 63,000 lives over next five years, experts warn

July 24, 2017
Alcohol consumption will cause 63,000 deaths in England over the next five years – the equivalent of 35 deaths a day – according to a new report from the University of Sheffield Alcohol Research Group.

Alcohol boosts recall of earlier learning

July 24, 2017
Drinking alcohol improves memory for information learned before the drinking episode began, new research suggests.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.