title: The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals.
abstract: BACKGROUND
  Threats to quality and patient safety may exist when necessary nursing care is omitted. Empirical research is needed to determine how missed nursing care is associated with patient outcomes.
  
  
  OBJECTIVE
  The aim of this study was to examine the relationship between missed nursing care and hospital readmissions.
  
  
  METHODS
  Cross-sectional examination, using three linked data sources-(1) nurse survey, (2) patient discharge data from three states (California, New Jersey and Pennsylvania) and (3) administrative hospital data- from 2005 to 2006. We explored the incidence of 30-day readmission for 160 930 patients with heart failure in 419 acute care hospitals in the USA. Logistic regression was used to assess the effect of missed care on the odds of readmission, adjusting for patient and hospital characteristics.
  
  
  RESULTS
  The most frequently missed nursing care activities across all hospitals in our sample included talking to and comforting patients (42.0%), developing and updating care plans (35.8%) and educating patients and families (31.5%). For 4 of the 10 studied care activities, each 10 percentage-point increase in the number of nurses reporting having missed the activity was associated with an increase in the odds of readmission by 2-8% after adjusting for patient and hospital characteristics. However, missed nursing care was no longer a significant predictor of readmission once adjusting for the nurse work environment, except in the case of the delivery of treatments and procedures (OR 1.08, 95% CI 1.02 to 1.14).
  
  
  CONCLUSIONS
  Missed care is an independent predictor of heart failure readmissions. However, once adjusting for the quality of the nurse work environment, this relationship is attenuated. Improvements in nurses' working conditions may be one strategy to reduce care omissions and improve patient outcomes.
authors: Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: J Margo Brooks
authors: JM
authors: Carthon
authors: Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Karen B
authors: KB
authors: Lasater
authors: Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Douglas M
authors: DM
authors: Sloane
authors: Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: Ann
authors: A
authors: Kutney-Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000451:nursing* / Q000628:therapy; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008297:Male; D009515:New Jersey; D009729:Nursing / Q000379:methods*; D009741:Nursing Staff, Hospital; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010414:Pennsylvania; D011787:Quality of Health Care; D014481:United States; D017132:Workplace
keywords: Chronic disease management; Healthcare quality improvement; Nurses