Estimating the economic cost of nurse sensitive adverse events amongst patients in medical and surgical settings

Abstract

Aims To identify the costs associated with nurse sensitive adverse events and the impact of these events on patients’ length of stay. Design Retrospective cohort study using administrative hospital data. Methods Data were sourced from patient discharge information (N = 5544) from six acute wards within three hospitals (July 2016–October 2017). A retrospective patient record review was undertaken by extracting data from the hospitals’ administrative systems on inpatient discharges, length of stay and diagnoses; eleven adverse events sensitive to nurse staffing were identified within the administrative system. A negative binomial regression is employed to assess the impact of nurse sensitive adverse events on length of stay. Results Sixteen per cent of the sample (n = 897) had at least one nurse sensitive adverse event during their episode of care. The model revealed when age, gender, admission type and complexity are controlled for, each additional nurse sensitive adverse event experienced by a patient was associated with an increase in the length of stay beyond the national average by 0.48 days (p = .001). Applying this to the daily average cost of inpatient stay per patient (€1456), we estimate the average cost associated with each nurse sensitive adverse event to be €694. Extrapolating this nationally, the economic cost of nurse sensitive adverse events to the health service in Ireland is estimated to be €91.3 million annually. Conclusion These potentially avoidable events are associated with a significant economic burden to health systems. The estimates provided here can be used to inform and prepare the way for future economic evaluations of nurse staffing initiatives that aim to improve care and safety. Impact As many of these nurse sensitive adverse events are avoidable, in addition to patient benefits, there is a potential substantial financial return on investment from strategies such as improved nurse staffing that can reduce their occurrence.

Association between nursing cost and patient outcomes in intensive care units: A retrospective cohort study of Belgian hospitals

“…The results of this study confirm the findings of other recently published papers in acute hospitals (Lasater et al, 2021c;Lasater et al, 2021a;Murphy et al, 2021;Sloane et al, 2018). Furthermore, these results should encourage policy makers and hospital managers to urgently invest in ICU nurses for better patient outcomes.…”

“…Optimal nurse staffing in acute care hospitals also reduces costs due to fewer readmissions, lower rates of admission to intensive care, and shorter lengths of stay (Aiken et al, 2021;McHugh et al, 2021;Murphy et al, 2021). Hospitals with better nursing resources (staffing, skill mix, education, work environment) have better patient outcomes and experiences, with no difference in cost (Lasater et al, 2021a;Lake et al, 2022).…”

A scoping review of patient safety research carried out in the Republic of Ireland

“…• The economic cost of adverse events to the health service in Ireland is estimated to be between €91.3 [ 26 ] and €194 million [ 25 ]…”

“…Two of these record reviews were undertaken as part of the Irish National Adverse Events studies [ 1 , 25 ], and examined trends in adverse event rates in the Irish healthcare system. The two remaining record reviews were conducted to estimate the economic cost of nurse-sensitive adverse events [ 26 ] and to compare the health system performance of 15 Organisation for Economic Co-operation (OECD) countries across seven patient safety indicators [ 27 ]. Furthermore, one study used a combination of survey and interview methods to examine the nature and frequency of medical error among junior doctors [ 28 ], and one study comprised a review of medico-legal claims to identify current adverse event reporting trends in Irish surgical specialties [ 29 ].…”

Associations between two nursing workload scales and the cost of intensive care unit nursing staff: A retrospective study of one Belgian hospital

“…However, high nurse workload in the ICU is associated with nurse‐sensitive patient outcomes (Driscoll et al, 2018) and an increased risk of burnout (Bruyneel et al, 2021). In addition to producing better results, costs avoided due to fewer readmissions and shorter length of stay have been demonstrated with provision of additional nursing staff (McHugh et al, 2021; Murphy et al, 2021). Therefore, an accurate analysis of the operating costs associated with human resources is necessary within an ICU to determine whether resources are properly allocated according to the individual needs of patients and to avoid understaffing or overstaffing the ICU workforce (Ricci de Araújo et al, 2021; Stafseth et al, 2018).…”