Background: Thirty-day hospital readmissions represent an international challenge leading to increased prevalence\nof adverse events, reduced quality of care and pressure on healthcare serviceâ??s resources and finances. There is a\nneed for a broader understanding of hospital readmissions, how they manifest, and how resources in the primary\nhealthcare service may affect hospital readmissions. The aim of the study was to examine how nurses and nursing\nhome leaders experienced the resource situation, staffing and competence level in municipal healthcare services,\nand if and how they experienced these factors to influence hospital readmissions.\nMethod: The study was conducted as a comparative case study of two municipalities affiliated with the same hospital,\nchosen for historical differences in readmission rates. Nurses and leaders from four nursing homes participated in focus\ngroups and interviews. Data were analyzed within and across cases.\nResults: The analysis resulted in four common themes, with some variation in each municipality, describing nursesâ??\nand leadersâ?? experience of the nursing home resource situation, staffing level and competence and their perception of\nfactors affecting hospital readmissions. The nursing home patients were described as becoming increasingly complex\nwith a subsequent need for increased nurse competence. There was variation in competence and staffing between\nnursing homes, but capacity building was an overall focus. Economic limitations and attempts at saving\nthrough cost-cutting were present, but not perceived as affecting patient care and the availability of medical\nequipment. Several factors such as nurse competence and staffing, physician coverage, and adequate communication\nand documentation, were recognized as factors affecting hospital readmissions across the municipalities.\nConclusion: Several factors related to nursesâ?? and leadersâ?? experience of the resource situation, staffing and\ncompetence level were suggested to affect hospital readmissions and the municipalities were similar in their\nanswers regarding these factors. Patients were perceived as more complex with higher patient mortality forcing longterm\nnursing homes to shift towards an acute care or palliative function, and short-term nursing homes to function as\nâ??small hospitalsâ?, requiring higher nurse competence. Staffing, competence and physician coverage did not seem to have\nadjusted to the new patient group in some nursing homes.
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