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Nurse staffing ratios linked to peds readmissions


Pediatric nurse staffing ratios are significantly associated with hospital readmission for children with common medical and surgical conditions, according to a study.

The study, led by a nurse scientist at Cincinnati Children’s Hospital Medical Center, is believed to be the first to examine the extent of the association between hospital nurse staffing levels and pediatric readmissions.

For the study, published May 7 on the website of the journal BMJ Quality & Safety, researchers examined common medical and surgical conditions such as pneumonia and appendectomy.

Heather Tubbs-Cooley, RN, PhD, a nurse scientist at Cincinnati Children’s, and researchers from the University of Pennsylvania found that each one-patient increase in a hospital’s average staffing ratio increased the odds of a medical patient’s readmission in 15 to 30 days by 11%. The odds of readmission for surgical patients increased by 48%.

Children treated in hospitals meeting a contemporary staffing benchmark of no more than four patients per nurse were significantly less likely to be readmitted in 15 to 30 days. Nursing staffing ratios had no effect on readmissions within the first 14 days after discharge, however.

The study team examined the outcomes of more than 90,000 children in 225 hospitals, using survey and discharge data from California, Florida, New Jersey and Pennsylvania and the American Hospital Association Annual Survey from these four states. All hospitals included in the study were non-federal, acute-care facilities with at least 50 pediatric discharges a year.

“Lower patient-to-nurse ratios hold promise for reducing preventable readmissions by allowing for more effective pre-discharge monitoring of patient conditions, improving discharge preparation and through enhanced quality improvement success,” Tubbs-Cooley said in a news release. “Delivering high-quality patient care requires nurses’ time and attention, and better staffing conditions likely allow nurses to thoroughly complete the clinical care that children and their families need in order to have a successful discharge.”

Despite the study results, Tubbs-Cooley is not ready to endorse mandated staffing ratios. “We have abundant evidence that better nurse staffing levels in hospitals are associated with better patient outcomes, but we lack robust data to guide decision-making regarding optimal staffing levels for a given unit or patient population. Producing that evidence will require different designs and methods than those we have relied on in the past.”

Read the study:


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