Rehospitalization in the Age of Nursing Shortages

For the first time, day to day, clinical personnel fluctuations are being made transparent. This new data required to be captured by the Affordable Care Act of 2010 and analyzed by Kaiser Health News is showing a not-so-pretty picture. Medicare has begun gathering and mining staffing information utilizing payroll data across more than 14,000 nursing homes. No longer is self-reporting for nursing homes an option.

Medicare has begun gathering and mining staffing information.

Along with the volatility of short staffing comes the potential for adverse outcomes such as events that may cause intervals in resident care that can lead to avoidable hospitalizations. While some estimates put as many as 60 percent of rehospitalizations as preventable, it has been recognized that there is a strong correlation to nursing shortages that could contribute to the vicious cycle of gaps in care and potentially avoidable adverse outcomes.


CMS Uses Payroll Data

Nurse Payroll Data

In a 2008 CMS report using payroll data, it was determined that for every 15-minute increase in average RN time per resident-day, there was an 8 percent decrease in the likelihood of being readmitted to the hospital. There is considerable evidence that higher staffing levels (particularly RN staffing levels) along with nursing staff competency, reduced attrition and intense supervision are all critical staffing strategies for maintaining the quality of resident care.

Higher staffing levels reduce attrition.

This, and the fact that Medicare began penalizing and cutting payments to hospitals where too many residents are readmitted within 30 days of discharge. Initial penalties were relatively modest and effected only three conditions—heart failure, pneumonia and heart attacks. However, they will gradually strengthen. While the real aim is to improve the quality of care for these skilled nursing residents, it is essential to keep in mind that reducing hospitalizations is critical as well.


Five Tips To Reduce Rehospitalizations

1. Keep the Nurses You Have

It’s long been said, people don’t quit jobs, they quit bosses. When employees feel appreciated and respected and that their input is valued in the workplace, they engage more openly in problem solving and improvement initiatives. By reducing staff turnover and improving morale and effectiveness, reductions in cost for recruiting and orienting staff or for interim use of agency is avoided or drastically reduced, improving outcomes.

2. Empower Nurses with Training

Nurse Education

Increased training for nurses, nursing aides, and other clinicians help to identify markers and situations that can lead to rehospitalizations before they become a crisis. Teach the use of maximized communication skills to ensure that nurses’ aides can assist in identifying warning signs quickly and communicate those changes to the nurse. These steps can be a precursor to crisis prevention.

3. Care for Residents In Your Facility

Encourage nurses to work with primary care doctors to allow the nursing facility to treat many acute episodes rather than ordering residents back to the hospital.

4. Know What Your Residents Want

As part of the resident’s routine care, inquire about what the resident and their family want, which should include whether they wish to be transferred for non-life saving situations. Residents may opt to stay where they are to recover versus being transported back to an acute setting.

5. Communicate Changes Across the Care Continuum

Ensuring that changes to the resident’s condition are identified and communicated for early assessment and intervention is vital in avoiding re-hospitalizations. Having methodologies in place to facilitate communication across the care continuum allows for multi-disciplinary involvement in addressing resident needs early and avoiding declines that may lead to unplanned rehospitalization.