Nurse staffing and the work environment linked to readmissions among older adults following elective total hip and knee replacement

In the International Journal for Quality in Health Care, Karen Lasater and Matthew McHugh examine the effect of nurse staffing and the work environment on 10- and 30-day unplanned readmissions for Medicare patients following elective total hip and knee replacement. The authors conducted a cross-sectional secondary data analysis using patient administrative data, nurse survey data, and hospital organizational data from acute care hospitals in California, Florida, New Jersey and Pennsylvania. Nurse survey responses were aggregated to construct hospital measures of nurse staffing and the practice environment. The sample included 112,017 Medicare patients in 495 hospitals. After adjusting for patient and hospital characteristics, the authors find patients had 8% higher odds of 30-day readmission and 12% higher odds of 10-day readmission for each additional patient per nurse. Patients cared for in the ‘best’ work environments had 12% lower odds of 30-day readmission. Their findings suggest that improving nurse staffing and the work environment may reduce readmissions among older adult orthopedic surgical patients.