Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study

Abstract

ObjectiveTo evaluate variation in Illinois hospital nurse staffing ratios and to determine whether higher nurse workloads are associated with mortality and length of stay for patients, and cost outcomes for hospitals.DesignCross-sectional analysis of multiple data sources including a 2020 survey of nurses linked to patient outcomes data.Setting: 87 acute care hospitals in Illinois.Participants210 493 Medicare patients, 65 years and older, who were hospitalised in a study hospital. 1391 registered nurses employed in direct patient care on a medical–surgical unit in a study hospital.Main outcome measuresPrimary outcomes were 30-day mortality and length of stay. Deaths avoided and cost savings to hospitals were predicted based on results from regression estimates if hospitals were to have staffed at a 4:1 ratio during the study period. Cost savings were computed from reductions in lengths of stay using cost-to-charge ratios.ResultsPatient-to-nurse staffing ratios on medical-surgical units ranged from 4.2 to 7.6 (mean=5.4; SD=0.7). After adjusting for hospital and patient characteristics, the odds of 30-day mortality for each patient increased by 16% for each additional patient in the average nurse’s workload (95% CI 1.04 to 1.28; p=0.006). The odds of staying in the hospital a day longer at all intervals increased by 5% for each additional patient in the nurse’s workload (95% CI 1.00 to 1.09, p=0.041). If study hospitals staffed at a 4:1 ratio during the 1-year study period, more than 1595 deaths would have been avoided and hospitals would have collectively saved over $117 million.ConclusionsPatient-to-nurse staffing ratios vary considerably across Illinois hospitals. If nurses in Illinois hospital medical–surgical units cared for no more than four patients each, thousands of deaths could be avoided, and patients would experience shorter lengths of stay, resulting in cost-savings for hospitals.

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A repeated cross-sectional study of nurses immediately before and during the COVID-19 pandemic: Implications for action

“…The unfunded mandate resulted in patients in California hospitals currently receiving, on average, 2-3 more hours a day of registered nurse care than patients in other states ( Dierkes, et al, 2021 ). Similar safe nurse staffing legislation has been considered in other states but despite research estimating improved patient outcomes and cost savings ( Lasater, et al, 2021a ; Lasater, et al, 2021b ), no other states have implemented minimum hospital nurse staffing requirements.…”

Cost consequences of unscheduled emergency admissions in cancer patients in the last year of life

“…Although regression models explained 41% of LOS variation, evidently, factors not included in the data greatly influence LOS. Whilst staffing ratios may be a factor [ 37 ], their attributable weighting is unclear. Moreover, many administrative datasets do not provide standardised reporting; therefore, minimum data sets and indicator development should seek to harmonize across jurisdictions [ 38 ], since a review of palliative care costing in the UK [ 39 ] suggested lacking data has implications on how palliative care (and palliative care research) is planned and funded.…”