Staff Turnover Linked to Poor Patient Outcomes in LTCs

Two recent studies suggest that preventing staff turnover should be given greater emphasis in long-term care facilities (LTCs), Advanced Healthcare Network for Nurses reports. The studies examined the relationship between turnover of nursing staff and quality of care for nursing homes residents and found negative outcomes for patients in facilities with high turnover.

Published in December 2013, both studies were based on data from the 2004 National Nursing Home Survey. The first, "Are Nursing Home Survey Deficiencies Higher in Facilities with Greater Staff Turnover," found that turnover for both licensed nurses and certified nursing assistants (CNAs) were associated with problems in quality of care, qualify of life, and resident behavior deficiencies. The second study, "Turnover Staffing, Skill Mix, and Resident Outcomes in a National Sample of U.S. Nursing Homes," found a relationship between high turnover among CNAs and adverse patient outcomes such as pressure ulcers, urinary tract infections, and pain.

An INQRI study led by Robin Newhouse and Laura Morlock, published in the May 2013 issue of Medical Care, underscores the importance of nurse staffing in providing quality care. The researchers tested in 23 rural hospitals a quality collaborative intervention to improve care for heart failure patients. At the end of the study, the researchers found no quantitative difference between the intervention and control groups on implementation of the key measures. They did find that hospitals with lower turnover in nurse staffing implemented more of the measures. The researchers assert that the study speaks to the central role of nurses in quality improvement.

INQRI also looked at patient outcomes in LTCs in The Res-Care-AL Intervention Study.  Researchers, led by Barbara Resnick and Sheryl Zimmerman, conducted a randomized controlled trial to test Function Focused Care – Assisted Living, an intervention designed to maintain and improve function, physical activity, muscle strength, psychosocial outcomes, and decrease adverse events (pain, falls, and hospitalizations) among assisted living residents.

Timing of Hospital Admissions Affects Outcomes for Heart Failure Patients

Research results presented at the annual meeting of the Heart Failure Association of the European Society of Cardiology show that heart failure patients who are admitted to hospitals in January, on Fridays and overnight have the highest death rates and longest hospital stays. Those admitted between 6am and noon had better outcomes than patients admitted in the evening, right before the weekend or in the middle of the night.

The study, which examined 14 years of data on more than 900,000 heart failure patients at New York hospitals, suggests that staffing plays a key role in outcomes, according to David Kao of the University of Colorado School of Medicine, who led the research team.

An INQRI-funded study led by Patti Hamilton and Gretchen Gemeinhardt revealed that patients admitted to hospitals during evenings and weekends ("off-peak" hours) experience more health problems. Nurses who work off-peak hours report that communication with other health providers is more difficult during those hours than during peak hours, which contributes to the poorer patient outcomes.

Another INQRI study, led by Robin Newhouse and Laura Morlock, and recently published in Medical Care, found that rural hospitals with lower nurse turnover and better practice environments were better able to implement a quality collaborative intervention aimed at improving care for heart failure patients.