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A 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 medical/surgical patients. 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 Marquette University 17

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