Associations Between Daily Nurse Staffing Levels and Daily Hospitalizations and ED Visits in Nursing Homes.
Dana B Mukamel, Debra Saliba, Heather Ladd and 1 others
PMID 35948066WHAT IT FOUND
Higher nursing home staffing on the day of transfer was associated with more hospitalizations, while higher staffing the day before was associated with fewer.
This suggests adequate prior-day staffing helps prevent transfers, but same-day staffing facilitates necessary assessments and immediate triage.
Key findings
01More RN and LPN hours on the same day as transfer were associated with increased hospitalizations, typically around 2% per FTE.
02More RN and LPN hours on the day prior to transfer were associated with decreased hospitalizations, mostly between -0.7% and -0.9% per FTE.
03The association between staffing and hospitalization depends on the timing of the staffing measurement relative to the transfer event.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study design is observational and cannot prove causation; it identifies associations between staffing levels and transfer events. ED visit data was limited to Medicare Fee-for-Service residents, excluding those in Medicare Advantage plans. Staffing data was aggregated at the facility level, so it is unknown if specific residents received more or less individual nurse time. The data did not account for other resources that affect transfers, such as immediate access to labs, X-rays, or specialists.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institutes of Health.
The easy way to misread this
Do not interpret the association between higher same-day staffing and more hospitalizations as evidence that increased staffing causes unnecessary transfers. The authors suggest this reflects nurses' ability to identify residents who require immediate care, whereas the protective effect of prior-day staffing suggests prevention of deterioration.