Facility-Level Factors and Outcomes After Skilled Nursing Facility Admission for Trauma and Surgical Patients.
Lucas W Thornblade, Saman Arbabi, David R Flum and 3 others
PMID 29042263WHAT IT FOUND
In skilled nursing facilities, fewer beds per registered nurse was associated with fewer deaths within a year, fewer hospital readmissions and more patients discharged home after trauma or surgery.
Facilities with more trauma or surgical patients also had fewer readmissions and better discharge.
Key findings
01Facilities with fewer beds per nurse had lower adjusted odds of one-year mortality, hospital readmission and failure to discharge home for both trauma and surgical patients.
02The association was stronger for registered nurses than licensed practical nurses: fewer beds per registered nurse was consistently linked to better outcomes, while fewer beds per licensed practical nurse did not show the same pattern.
03Facilities with a higher share of trauma or surgical patients had lower adjusted odds of readmission and failure to discharge home, although higher trauma share alone was not associated with mortality.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is observational, so it cannot show that changing nurse staffing or patient mix caused the outcomes. It used Medicare claims from five states and Medicare-certified skilled nursing facilities, so it may not apply to non-Medicare patients or other settings. Nurse staffing was measured as the number of employed nurses in the first quarter and used as an estimate for the whole study period. Facility data did not capture many possible care-quality factors, such as indicators of decline in patient function during the skilled nursing stay. The analysis excluded facilities with fewer than 9 trauma or surgical admissions, which may limit what it says about facilities that rarely admit these patients. Some clinical variables were missing, and values were imputed; sensitivity analysis showed no difference between complete and imputed data.
Declared interests
The article is listed as supported by the National Institutes of Health and U.S. government. The authors reported no conflicts of interest related to this work.
The easy way to misread this
Do not read this as proof that adding registered nurses or concentrating trauma and surgical patients in a facility causes better outcomes. The study is observational, used facility nurse counts from one quarter, and could not measure many care-quality factors, so the staffing and density ratios may reflect other differences between facilities.