Issuu on Google+


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


Discover 2012