Background:: Provisions of the Affordable Care Act that increase hospitals’ financial accountability for preventable readmissions have heightened interest in identifying system-level interventions to reduce readmissions.
Objectives:: To determine the relationship between hospital nursing; that is, nurse work environment, nurse staffing levels, and nurse education, and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia.
Method and Design:: Analysis of linked data from California, New Jersey, and Pennsylvania that included information on the organization of hospital nursing (ie, work environment, patient-to-nurse ratios, and proportion of nurses holding a BSN degree) from a survey of nurses, as well as patient discharge data, and American Hospital Association Annual Survey data. Robust logistic regression was used to estimate the relationship between nursing factors and 30-day readmission.
Results:: Nearly 1 quarter of heart failure index admissions [23.3% (n = 39,954)], 19.1% (n=12,131) of myocardial infarction admissions, and 17.8% (n = 25,169) of pneumonia admissions were readmitted within 30 days. Each additional patient per nurse in the average nurse’s workload was associated with a 7% higher odds of readmission for heart failure [odds ratio (OR) = 1.07; confidence interval CI, 1.05–1.09], 6% for pneumonia patients (OR = 1.06; CI, 1.03–1.09), and 9% for myocardial infarction patients (OR = 1.09; CI, 1.05–1.13). Care in a hospital with a good versus poor work environment was associated with odds of readmission that were 7% lower for heart failure (OR = 0.93; CI, 0.89–0.97), 6% lower for myocardial infarction (OR = 0.94; CI, 0.88–0.98), and 10% lower for pneumonia (OR = 0.90; CI, 0.85–0.96) patients.
Conclusions:: Improving nurses’ work environments and staffing may be effective interventions for preventing readmissions.