Hospitals with good work environment have low readmission rates

New research from the University of Pennsylvania School of Nursing has found that Medicare patients treated in hospitals with a good work environment for nurses had up to ten percent lower odds of readmission than those treated in hospitals with a poor work environment.

Preventable hospital readmissions are a source of unnecessary costs to Medicare—more than $15 billion annually, and Medicare is now penalizing hospitals with excessive rates of readmissions.

After examining data from more than 200,000 nurses and 412 hospitals in California, Pennsylvania and New Jersey, researchers determined the likelihood of readmission within 30-days among Medicare patients over age 65 with heart failure, heart attack, and pneumonia was seven percent, six percent and ten percent lower when treated in hospitals with good work environments.

"Our results suggest that improving nurses' work environment and reducing nurses' workload are organization-wide reforms that could result in fewer readmissions for Medicare beneficiaries with common medical conditions," said lead author Matthew D. McHugh, PhD, JD, MPH, CRNP, a health policy expert at Penn Nursing, in the January 2013 issue of Medical Care. "This is consistent with the evidence showing significant associations between the nurse work environment, staffing, and other patient outcomes."

The researchers suggest that system-based interventions to improve care begin within the nursing care environment. All hospitalized patients are exposed to bedside nursing throughout their stay and combining targeted transitional care, the coordination of healthcare during the transition from hospital to home, with high-quality inpatient nursing care will produce more positive outcomes for all patients.

Hiring more staff nurses to cut down on current patient workloads could help the nursing work environment, wrote Dr. McHugh. While this may be costly, hospitals may be able to make up for these costs with increased productivity, reduced costs lost to turnover and retraining, improved patient outcomes, and reductions in readmissions and postdischarge services.

"To work effectively, nurses must practice in an environment that reinforces their professional role and autonomy, provides adequate resources, demonstrates consistent and high-quality managerial support and leadership, and includes nursing in institutional decision making," said Dr. McHugh. "The challenge of readmissions will require a range of interventions. One potentially effective means of reducing overall readmissions may come through improving the organization and delivery of hospital nursing services."