Researchers in a study funded by the Robert Wood Johnson Foundation found that when registered nurse nonovertime staffing was higher, the odds of patient readmission were lower, and when RN overtime hours were higher, ED use was higher.

In addition, a cost-benefit analysis estimated that increasing nonovertime staffing by .75 hours per patient per day increased hospitals' cost by $197.92 per hospitalized patient but saved payers $607.51 per patient. Reducing RN overtime staffing by .07 hours per patient day resulted in hospital savings of $8.18 per hospitalized patient and $10.98 in savings per hospitalized patient to payers. The study also found a positive correlation between the number of RN staffing hours and patients' satisfaction with the quality of discharge teaching and subsequent readiness to go home.

Using a cost-analysis projection for the 16 nursing units in the study, researchers estimated annual net savings of $11.64 million associated with increasing nonovertime hours and $544,000 associated with decreasing overtime hours. In current payment models, however, payer savings from reduced readmissions or ED use would not be applied to costs for increased RN staffing.

The study's findings support recommendations to monitor and manage unit-level nurse staffing to ensure optimal post-discharge results; implement assessment of the quality of discharge teaching and patients' readiness for discharge as part of the discharge procedure; and realign payment structures so that the cost of RN staffing is offset by the savings from reductions in unplanned readmissions and ED visits after discharge.

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