title: Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Nested panel data with hospital and unit-level fixed effects and patient and unit-level control variables.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Marquette University College of Nursing, Milwaukee, WI 53201-1881, USA. marianne.weiss@marquette.edu
authors.forename: Marianne E
authors.initials: ME
authors.lastname: Weiss
authors.forename: Olga
authors.initials: O
authors.lastname: Yakusheva
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Bobay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000191:economics* / Q000600:supply & distribution; D010351:Patient Discharge / Q000191:economics* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000191:economics* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012307:Risk Factors; D014481:United States