Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization

Health Serv Res. 2011 Oct;46(5):1473-94. doi: 10.1111/j.1475-6773.2011.01267.x. Epub 2011 Apr 21.


Objectives: To determine the impact of unit-level nurse staffing on quality of discharge teaching, patient perception of discharge readiness, and postdischarge readmission and emergency department (ED) visits, and cost-benefit of adjustments to unit nurse staffing.

Data sources: Patient questionnaires, electronic medical records, and administrative data for 1,892 medical-surgical patients from 16 nursing units within four acute care hospitals between January and July 2008.

Design: Nested panel data with hospital and unit-level fixed effects and patient and unit-level control variables.

Data collection/extraction: Registered nurse (RN) staffing was recorded monthly in hours-per-patient-day. Patient questionnaires were completed before discharge. Thirty-day readmission and ED use with reimbursement data were obtained by cross-hospital electronic searches.

Principal findings: Higher RN nonovertime staffing decreased odds of readmission (OR=0.56); higher RN overtime staffing increased odds of ED visit (OR=1.70). RN nonovertime staffing reduced ED visits indirectly, via a sequential path through discharge teaching quality and discharge readiness. Cost analysis projected total savings from 1 SD increase in RN nonovertime staffing and decrease in RN overtime of U.S.$11.64 million and U.S.$544,000 annually for the 16 study units.

Conclusions: Postdischarge utilization costs could potentially be reduced by investment in nursing care hours to better prepare patients before hospital discharge.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Emergency Service, Hospital / economics*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Health Services Research
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Nursing Staff, Hospital / economics*
  • Nursing Staff, Hospital / supply & distribution
  • Patient Discharge / economics*
  • Patient Discharge / statistics & numerical data
  • Patient Readmission / economics
  • Patient Readmission / statistics & numerical data
  • Personnel Staffing and Scheduling / economics*
  • Personnel Staffing and Scheduling / statistics & numerical data
  • Quality of Health Care*
  • Risk Factors
  • United States