Associations Between Nurse Staffing Levels and 30‐ and 60‐Day Readmissions for Acute Care Patients With Intellectual and Developmental Disability

The purpose of this study was to examine the association between hospital nurse staffing levels and 30- and 60-day readmissions among patients with intellectual and/or developmental disabilities (IDD). This cross-sectional correlational study utilized secondary data from 595 acute care, nonfederal hospitals in California, Florida, New Jersey, and Pennsylvania in 2016. Data were obtained from three sources: the American Hospital Association Annual Survey, the RN4CAST-US nurse survey, and state patient hospital discharge summaries. The analytic sample included 39,558 hospital stays for 28,446 adults with IDD aged 18 and older who were discharged alive. In adjusted models, every additional patient added to a nurse's workload was associated with 7% higher odds of 30-day readmission OR = 1.07 (95% CI [1.03, 1.12], p = 0.001) and 9% higher odds of 60-day readmission OR = 1.09 (95% CI [1.04, 1.13], p < 0.001) among patients with IDD. The average nurse staffing level across hospitals was 4.7 patients per nurse (SD = 0.99). Staffing levels varied by hospital characteristics, with large hospitals, major teaching hospitals, and hospitals in California having better staffing ratios. The study population had a 30-day readmission rate of 17.1%, which is 27% higher than the average adult hospital 30-day readmission rate in the US in 2018. This study demonstrates the association of nurse staffing levels with readmission odds for patients with IDD. Improving nurse staffing levels is a system-based solution that can potentially improve outcomes for patients with IDD, who often require intensive nursing care.