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

Int J Qual Health Care. 2016 Apr;28(2):253-8. doi: 10.1093/intqhc/mzw007. Epub 2016 Feb 2.


Objective: To examine the effect of nurse staffing and the work environment on 10- and 30-day unplanned readmissions for US Medicare patients following elective total hip and knee replacement.

Design: A cross-sectional analysis of secondary data.

Setting: Acute care hospitals in California, Florida, New Jersey and Pennsylvania, during 2006.

Participants: Medicare patients (n = 112 017) admitted to an acute care hospital for an elective total hip or knee replacement.

Main outcome measures: The adjusted odds ratio (OR) of experiencing an unplanned readmission within 10 and 30 days of discharge following an elective total hip or knee replacement.

Results: Our sample included 112 017 Medicare patients in 495 hospitals. Nearly 6% of the patients were readmitted within 30 days; more than half of whom were rehospitalized within 10 days. Adjusted for patient and hospital characteristics, 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.

Conclusions: Readmission outcomes following major joint replacement are associated with hospital nursing care. Attention to nurse work conditions may be central to improving readmissions in this postoperative Medicare population.

Keywords: hip replacement; knee replacement; nursing; readmission; work environment.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip / adverse effects
  • Arthroplasty, Replacement, Hip / nursing*
  • Arthroplasty, Replacement, Hip / standards
  • Arthroplasty, Replacement, Hip / statistics & numerical data
  • Arthroplasty, Replacement, Knee / adverse effects
  • Arthroplasty, Replacement, Knee / nursing*
  • Arthroplasty, Replacement, Knee / standards
  • Arthroplasty, Replacement, Knee / statistics & numerical data
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Nursing Staff, Hospital / standards
  • Nursing Staff, Hospital / statistics & numerical data
  • Nursing Staff, Hospital / supply & distribution*
  • Patient Readmission / statistics & numerical data*
  • United States / epidemiology
  • Workplace / standards*
  • Workplace / statistics & numerical data