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.
© The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.