Do hospital length of stay and staffing ratio affect elderly patients' risk of readmission? - A nation-wide study of Norwegian hospitals

Objective. To test whether there is an association between hospital operating conditions such as average length of stays (LOS) and staffing ratio, and elderly patients' risk of readmission. Data Sources. The main data source was a national patient database of admissions to all acute-care Norwegian hospitals during the year of 1996. Study Design. It is a cross-sectional study, where Cox' regression analysis was used to test the factors acting on the probability of early unplanned readmission (within 30 days), and later occurring ones. The principal hospital variables included average hospital LOS and staffing ratio (discharges per man-years of personnel). Adjusting patient variables in the model included age, gender, and cost-weights of the Diagnosis Related Groups (DRGs). Data Extraction Methods. The selected material included discharges from 59 hospitals, and 113,055 elderly patients ( :67 years). Multiple admissions to the same hospital were linked together chronologically, and additional hospital data were matched on. To maximize the association between the index stay and the defined outcome (unplanned readmission), no intervening planned admission was accepted. Principal Findings. Being admitted to a hospital with relatively short aver-age LOS increased the patient's risk of early readmission significantly. In addition it was found that more intensive care (more staff) could have a compensatory effect. Furthermore, the predictive factors were shown to be time dependent, as hospital variables had much less impact on readmissions occurring late (within 90-180 days). Conclusions. The results give support to the assumption of a link between hospital operating conditions and patient outcome.