Impact of Nursing on Readmissions, Failure to Rescue & Mortality in DoD Hospitals

Nurse staffing and the practice environment have been associated with patient outcomes in civilian hospitals, including patient mortality, readmissions and failure to rescue (FTR). Work by Aiken and team have shown striking relationships between better staffing and more professional nursing practice environments (such as that seen in Magnet hospitals) and lower mortality and other negative outcomes. Through our work with the Patient CaringTouch System (PCTS), an innovative care model in Army hospitals, we have shown that the practice environment has improved to exceed that of Magnet hospitals. The next logical step in this program of research is to explore whether these favorable practice environments are associated with better patient outcomes.

The purpose of this study is to investigate the relationships between the practice environment, nurse staffing, mortality, readmission, and FTRs in military hospitals. We also propose to compare these results with a set of civilian hospitals.

The specific aims of this project are to: 1) Evaluate whether professional nursing practice environments and nurse staffing in military hospitals are associated with the following patient outcomes:  30-day mortality, 30-day readmissions, and FTR; and 2) Compare the professional nursing practice environment, nurse staffing, and patient outcomes in military hospitals with those in Magnet and non-Magnet civilian hospitals.

We will use the Practice Environment Scale of the Nursing Work Index (PES-NWI) and staffing data from all 23 Army and multiservice hospitals for the years 2011 (pre-PCTS implementation) and 2014 (post-PCTS implementation). For the same years, we will obtain patient level data from which to calculate mortality, readmissions, and FTR for the 23 military hospitals, using hospital identification codes to merge the nursing with the patient/hospital data for analysis. Then, using comparable civilian nursing data from the National Database of Nursing Quality Indicators and civilian patient outcomes data from the Centers for Medicare and Medicaid Services Hospital Compare database, we will determine differences between military and civilian Magnet and non-Magnet hospitals in the outcome measures, controlling for differences in nursing and hospital characteristics.

This study will provide data to support several recommendations of the 2014 Military Health System (MHS) Review, i.e., to demonstrate the integration of standardized measures of mortality and readmissions into routine performance improvement monitoring, and to compare military performance with other health care systems. This is the first effort in the military to explore the impact of nursing on mortality, readmissions and FTR.