Background:

• Higher nurse staffing levels measured at the organizational level have been associated with better inpatient outcomes and lower 30-day mortality rates.
• Poor discharge preparation has been associated with difficulty coping at home after discharge, and with re-hospitalizations

Key Findings:

• Higher non-overtime RN hours per patient day were associated with decreased likelihood of re-hospitalization within 30 days post-discharge.
• Higher overtime RNHPPD were associated with increased likelihood of an ED visit.
• Higher non-overtime RN staffing was indirectly associated reduced ED visits, via a sequential path through quality of discharge teaching and discharge readiness.
• Investments in increased RNHPPD could produce substantial potential savings from reduced post-discharge utilization costs.
• Savings would be retained by the payers, which reduces the internal financial return to the organization from investment in nurse staffing.
• The study findings support these recommendations: monitor and manage unit-level nurse staffing to minimize re-hospitalizations and ED use after hospital discharge; assess quality of discharge teaching and readiness standard practices within hospital discharge preparation processes; and realign payment incentives to offset the costs of increasing nurse staffing, avoiding costs through improved post-discharge utilization.