Medical College of Wisconsin
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Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization. Health Serv Res 2011 Oct;46(5):1473-94 PMID: 21517836 PMCID: PMC3207188

Pubmed ID





OBJECTIVES: To determine the impact of unit-level nurse staffing on quality of discharge teaching, patient perception of discharge readiness, and postdischarge readmission and emergency department (ED) visits, and cost-benefit of adjustments to unit nurse staffing.

DATA SOURCES: Patient questionnaires, electronic medical records, and administrative data for 1,892 medical-surgical patients from 16 nursing units within four acute care hospitals between January and July 2008.

DESIGN: Nested panel data with hospital and unit-level fixed effects and patient and unit-level control variables.

DATA COLLECTION/EXTRACTION: Registered nurse (RN) staffing was recorded monthly in hours-per-patient-day. Patient questionnaires were completed before discharge. Thirty-day readmission and ED use with reimbursement data were obtained by cross-hospital electronic searches.

PRINCIPAL FINDINGS: Higher RN nonovertime staffing decreased odds of readmission (OR=0.56); higher RN overtime staffing increased odds of ED visit (OR=1.70). RN nonovertime staffing reduced ED visits indirectly, via a sequential path through discharge teaching quality and discharge readiness. Cost analysis projected total savings from 1 SD increase in RN nonovertime staffing and decrease in RN overtime of U.S.$11.64 million and U.S.$544,000 annually for the 16 study units.

CONCLUSIONS: Postdischarge utilization costs could potentially be reduced by investment in nursing care hours to better prepare patients before hospital discharge.

Author List

Weiss ME, Yakusheva O, Bobay KL


Kathleen Bobay PhD Associate Professor in the Nursing department at Marquette University
Marianne Weiss DNSc Associate Professor in the College of Nursing department at Marquette University


2-s2.0-80052519145   60 Citations

MESH terms used to index this publication - Major topics in bold

Aged, 80 and over
Emergency Service, Hospital
Health Services Research
Length of Stay
Middle Aged
Nursing Staff, Hospital
Patient Discharge
Patient Readmission
Personnel Staffing and Scheduling
Quality of Health Care
Risk Factors
United States
jenkins-FCD Prod-353 9ccd8489072cb19f5b9f808bb23ed672c582f41e