trip to the hospital is rarely
quality of discharge teaching patients
out how you make those upstream changes
a pleasant experience — all
received. They also researched readmission
when there’s no benefit to doing so.”
jokes about hospital food
data within hospital databases.
notwithstanding. There’s the
stress of undergoing a procedure, however major or minor it may be, the talk about
What did they find? They found their hunch to be dead-on. “When nurse staffing is higher,” says
Though some health care reform legislation does change the payment model to incentivize preventing readmissions, it’s not an overnight process.
risks involved and hypothetical worst-
Yakusheva, “patients feel the quality of
case scenarios. There’s the pain of the
care they receive is better and thus feel
made three recommendations based on
procedure itself, the pain of recovery, of
more prepared at the time they leave
their findings: 1.) Keep staffing levels
rehabilitation — and then there’s the bill.
the hospital. Additionally, having fewer
more stable and avoid understaffing;
overtime nursing hours leads to a drop in
2.) Implement a standardized protocol for
emergency room visits after discharge.”
assessing the quality of discharge teaching
All things considered, however, the cost a patient incurs is minimal compared with the overall cost of admission. And
Nevertheless, Weiss and her team have
According to their findings, just 45
and a patient’s readiness for discharge;
when it comes to the cost of readmission?
minutes of extra nursing care per patient
3.) Support the transition in health care
Generally, those costs can be avoided —
per day can reduce the patient readmis-
financing at the national level toward the
certainly not all the time, but some of the
sion rate by 44 percent. That 45-minute
bundling of payments for hospital and
time — with greater nurse/patient interac-
increase in non-overtime nursing care
post-discharge care and incentivizing of
tion and better discharge teaching.
could also save the 16 nursing units in
appropriate staffing levels to achieve the
the study more than $11 million a year.
best possible patient outcomes.
Such was the hunch, anyway, of an interdisciplinary team of researchers at Marquette that included Drs. Marianne Weiss, Olga Yakusheva and Kathleen
So why aren’t hospitals doing back flips over these findings? The problem is health care’s current
“I think what our research does more than anything,” says Weiss, “is highlight what we already know about nurses.
Bobay. The three joined forces in 2008 for
payment methodologies. They don’t
Namely, that RNs make a difference. The
a study that looked at 16 nursing units in
provide any advantage for hospitals to
number of total hours an RN spends in
four Midwestern hospitals and included
increase the number of nurses per shift.
direct contact with a patient every day
information collected firsthand from 1,892
Further, payer savings from reduced
makes a difference.”²
readmissions aren’t applied to offset the
“Our research was something we could do together but not alone,” says
costs of increased staffing. “Here’s the dilemma with what we
Weiss who, along with Bobay, is an
found,” says Weiss. “Essentially, if you
associate professor in the College of
increase staffing a little bit, readmissions
Nursing. Yakusheva is an assistant
decrease. That’s what the data shows.
professor of economics in the College of
The problem is hospitals accrue the cost
Business Administration (currently doing a
of staffing, but they don’t see the benefit
post-doc at Yale School of Public Health).
on the readmission side. The payers see
The team collected data from electronic hospital data systems and from patients
the greater benefit. So it’s an interesting dance to figure
themselves, looking at staffing data as it related to registered nurses and the
Drs. Kathleen Bobay, Olga Yakusheva and Marianne Weiss