Nurse staffing and the work environment linked to readmissions among older adults following elective total hip and knee replacement.

OBJECTIVE To examine the effect of nurse staffing and the work environment on 10- and 30-day unplanned readmissions for US Medicare patients following elective total hip and knee replacement. DESIGN A cross-sectional analysis of secondary data. SETTING Acute care hospitals in California, Florida, New Jersey and Pennsylvania, during 2006. PARTICIPANTS Medicare patients (n = 112 017) admitted to an acute care hospital for an elective total hip or knee replacement. MAIN OUTCOME MEASURES The adjusted odds ratio (OR) of experiencing an unplanned readmission within 10 and 30 days of discharge following an elective total hip or knee replacement. RESULTS Our sample included 112 017 Medicare patients in 495 hospitals. Nearly 6% of the patients were readmitted within 30 days; more than half of whom were rehospitalized within 10 days. Adjusted for patient and hospital characteristics, patients had 8% higher odds of 30-day readmission and 12% higher odds of 10-day readmission, for each additional patient per nurse. Patients cared for in the best work environments had 12% lower odds of 30-day readmission. CONCLUSIONS Readmission outcomes following major joint replacement are associated with hospital nursing care. Attention to nurse work conditions may be central to improving readmissions in this postoperative Medicare population.