New research suggests that nurse staffing levels and environment are key contributors to keeping rehospitalization levels down for both hip and knee surgery patients.

Published in the International Journal for Quality in Health Care, a cross-sectional analysis of secondary data revealed that readmission outcomes following major joint replacement are linked with hospital nursing care. The researchers recognized that additional attention to nurse work conditions may be a key element to improving readmissions in the postoperative Medicare population.

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Nearly 6% of the study participants were readmitted within 30 days, of which more than half of whom were rehospitalized within 10 days. For each patient per nurse, patients had 8% higher odds of 30-day readmission and 12% higher odds of 10-day readmission. For those patients cared for in the “best work environments, they had 12% lower odds of 30-day readmission,” the authors wrote.

The researchers examined the data from more than 112 000 Medicare patients in nearly 500 acute care hospitals in California, Florida, New Jersey, and Pennsylvania. Study participants were admitted for an elective total hip or knee replacement.

The research was funded by the National Institute of Nursing Research and the Robert Wood Johnson Foundation Nurse Faculty Scholars Program.

“These study findings are consistent with decades of prior research demonstrating the role hospital nurses play in ensuring safe outcomes for surgical patients,” said Matthew McHugh, PhD, JD, MPH, RN, associate director of Penn’s Center for Health Outcomes and Policy Research (CHOPR). .

“Nurses work around-the-clock providing care to patients before, during, and after surgery,” he added, “making them the likely healthcare providers to identify and intervene on early warning signs that could lead to a negative health outcome.”


Lasater K, McHugh M. Nurse staffing and the work environment linked to readmissions among older adults following elective total hip and knee replacement. J Qual Health Care. 2016. doi:10.1093/intqhc/mzw007.