The Influence of Nurse Education Level on Hospital Readmissions—A Cost-Effectiveness Analysis

Abstract

Background: Readmissions are adverse, costly, and potentially preventable. The study aimed to evaluate the cost-effectiveness of reducing readmissions resulting from missed care, depending on the level of education of nurses, from the perspective of the service provider. Methods: We calculated missed care resulting in additional readmissions based on the longitudinal study conducted between 2012 and 2014, as well as readmissions that could have been potentially prevented by adding a 10% increase in hours of nursing care provided by BSN/MSc nurses for 2014. The cost-effectiveness analysis (CEA) was performed to calculate the cost-effectiveness of preventing one hospitalization in non-surgical and surgical wards by increasing the number of nursing hours provided by BSN/MSc nurses. Cost–benefit analysis (CBA) was performed, and the CBR (cost–benefit ratio) and BCR (benefit–cost ratio) were calculated. Results: Increasing the number of hours of nursing care (RN) by 10% decreased the chance for an unplanned readmission by 11%; (OR = 0.89; 95% CI: 0.78−1.01; p = 0.08) in non-surgical wards and 43% (OR = 0.57; 95% CI: 0.49−0.67; p < 0.001) in surgical wards. In non-surgical wards, the number of readmissions that were preventable with extra hours provided by BSN/MSc nurses was 52, and the cost-effectiveness ratio (CER) was USD 226.1. The number of preventable readmissions in surgical wards was 172, and the CER was USD 54.96. In non-surgical wards, the CBR was USD 0.07, while the BCR was USD 1.4. In surgical wards, the CBR was USD 0.02, and the BCR was USD 4.4. Conclusions: The results of these studies broaden the understanding of the relationship among nursing education, patient readmission, and the economic outcomes of hospital care. According to the authors, the proposed intervention has an economic justification. Hence, the authors recommend it for approval by the service provider.

A bachelor's degree for entering the nursing profession: A scoping review for supporting informed health care policies

“…(2019) Hospital Belgium Retrospective observational study proportion of staffing level with bachelor's degree 68 estimates, seven hospitals, 28 wards, 34,267 admissions, 1860 patients The proportion of nurses with a bachelor's degree was negatively correlated with the composite mortality rate ( B = −8.845, p = 0.023). A higher proportion of nurses with bachelor's degrees is related to a reduction in patient mortality Wieczorek-Wójcik et al. (2022) Hospital Poland Retrospective longitudinal observational study comparison between working hours of BScN/MScN nurses and nurses without higher education 14,369 patients from eight wards (four surgical and four non-surgical wards) Decrease in re-admissions by 8.8 per 1000 patient days and by 24.7 per 1000 patient (−0.879; SD = 0.283) * and in surgical wards (−2.474; SD = 0.700) # (* p < 0.05, # p < 0.01).…”

“…The results regarding disease complications and length of stay were heterogeneous ( Audet et al., 2018b ; Backhaus et al., 2017 ; Choi et al., 2021 ; Lasater et al., 2021 ; O'Brien et al., 2017 ). Wieczorek-Wójcik et al. (2022) and O'Brien et al.…”

“…(2018) (1/1) n 5 4 1 % 100 80.0 0.0 20.0 Financial benefits O'Brien et al. (2017) (1/1) Wieczorek-Wòjcik et al. (2022) n 2 2 % 100 100.0 0.0 0.0 …”

Missed nursing care in relation to registered nurses' level of education and self‐reported evidence‐based practice

“…In Sweden, graduating from nursing programs provides a nursing diploma with a bachelor's degree. In 2021, the National Academies of Sciences made a recommendation that an 80% proportion of RNs with a bachelor's degree in nursing to provide safe care (National Academies of Sciences, 2021), which is also supported by research showing that such a proportion leads to significantly reduced odds of in‐hospital mortality, seven‐day readmission, and 30‐day readmission, and a shorter length of stay in the acute care hospital (Aiken et al, 2014; Wieczorek‐Wójcik et al, 2022). Despite the recommendations and extensive research supporting the impact of RNs on patient outcomes, Sweden has no recommendations about the proportions of RNs with different educational levels in healthcare.…”

“…Sciences, 2021), which is also supported by research showing that such a proportion leads to significantly reduced odds of in-hospital mortality, seven-day readmission, and 30-day readmission, and a shorter length of stay in the acute care hospital (Aiken et al, 2014;Wieczorek-Wójcik et al, 2022). Despite the recommendations and extensive research supporting the impact of RNs on patient outcomes, Sweden has no recommendations about the proportions of RNs with different educational levels in healthcare.…”