Every spring DISCOVER: Marquette University Research and Scholarship showcases some of the most interesting research happening on Marquette's campus. Learn more through the links below.
A trip to the hospital is rarely a pleasant experience — all jokes about hospital food notwithstanding. There’s the quality of discharge teaching patients received. They also researched readmission data within hospital databases. What did they find? They found their hunch to be dead-on. “When nurse staffing is higher,” says Yakusheva, “patients feel the quality of care they receive is better and thus feel more prepared at the time they leave the hospital. Additionally, having fewer overtime nursing hours leads to a drop in emergency room visits after discharge.” According to their findings, just 45 minutes of extra nursing care per patient per day can reduce the patient readmission rate by 44 percent. That 45-minute increase in non-overtime nursing care could also save the 16 nursing units in the study more than $11 million a year. So why aren’t hospitals doing back flips over these findings? The problem is health care’s current payment methodologies. They don’t provide any advantage for hospitals to increase the number of nurses per shift. Further, payer savings from reduced readmissions aren’t applied to offset the costs of increased staffing. “Here’s the dilemma with what we found,” says Weiss. “Essentially, if you increase staffing a little bit, readmissions decrease. That’s what the data shows. The problem is hospitals accrue the cost of staffing, but they don’t see the benefit on the readmission side. The payers see the greater benefit. So it’s an interesting dance to figure out how you make those upstream changes when there’s no benefit to doing so.” Though some health care reform legislation does change the payment model to incentivize preventing readmissions, it’s not an overnight process. Nevertheless, Weiss and her team have made three recommendations based on their findings: 1.) Keep staffing levels more stable and avoid understaffing; 2.) Implement a standardized protocol for assessing the quality of discharge teaching and a patient’s readiness for discharge; 3.) Support the transition in health care financing at the national level toward the bundling of payments for hospital and post-discharge care and incentivizing of appropriate staffing levels to achieve the best possible patient outcomes. “I think what our research does more than anything,” says Weiss, “is highlight what we already know about nurses. Namely, that RNs make a difference. The number of total hours an RN spends in direct contact with a patient every day makes a difference.”² stress of undergoing a procedure, however major or minor it may be, the talk about risks involved and hypothetical worstcase scenarios. There’s the pain of the procedure itself, the pain of recovery, of rehabilitation — and then there’s the bill. All things considered, however, the cost a patient incurs is minimal compared with the overall cost of admission. And when it comes to the cost of readmission? Generally, those costs can be avoided — certainly not all the time, but some of the time — with greater nurse/patient interaction and better discharge teaching. Such was the hunch, anyway, of an interdisciplinary team of researchers at Marquette that included Drs. Marianne Weiss, Olga Yakusheva and Kathleen Bobay. The three joined forces in 2008 for a study that looked at 16 nursing units in four Midwestern hospitals and included information collected firsthand from 1,892 medical/surgical patients. “Our research was something we could do together but not alone,” says Weiss who, along with Bobay, is an associate professor in the College of Nursing. Yakusheva is an assistant professor of economics in the College of Business Administration (currently doing a post-doc at Yale School of Public Health). The team collected data from electronic hospital data systems and from patients themselves, looking at staffing data as it related to registered nurses and the Drs. Kathleen Bobay, Olga Yakusheva and Marianne Weiss Marquette University 17