The Effects of Nurse Staffing on Adverse Events, Morbidity, Mortality, and Medical Costs

Abstract

Background: Nurse staffing levels are an important working condition issue for nurses and believed to be a determinant of the quality of nursing care and patient outcomes. Objectives:To examine the effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Methods:Using two existing databases, the study sample included 232 acute care California hospitals and 124,204 patients in 20 surgical diagnosis-related groups. The adverse events included patient fall/injury, pressure ulcer, adverse drug event, pneumonia, urinary tract infection, wound infection, and sepsis. Multilevel analysis was employed to examine, simultaneously, the effects of nurse staffing and patient and hospital characteristics on patient outcomes.Results: Three statistically significant relationships were found between nurse staffing and adverse events. An increase of 1 hour worked by registered nurses (RN) per patient day was associated with an 8.9% decrease in the odds of pneumonia. Similarly, a 10% increase in RN Proportion was associated with a 9.5% decrease in the odds of pneumonia. Providing a greater number of nursing hours per patient day was associated with a higher probability of pressure ulcers. The occurrence of each adverse event was associated with a significantly prolonged length of stay and increased medical costs. Patients who had pneumonia, wound infection or sepsis had a greater probability of death during hospitalization. Conclusion:Patients are experiencing adverse events during hospitalization. Care systems to reduce adverse events and their consequences are needed. Having appropriate nurse staffing is a significant consideration in some cases.

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

“…These problems can often be effectively tackled on a standard ward through proactive patient care led by experienced qualified nursing staff, with prompt access to medical support when required. Adequate staffing of surgical wards with qualified nurses may improve patient safety [28,29] and reduce the incidence of pneumonia, surgical site infection, and postoperative sepsis [30][31][32]. Hospitals with higher nurse staffing levels may also be more cost-effective in terms of postoperative outcomes (lower mortality with similar costs), especially for high-risk surgical patients [33].…”

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

“…However, two studies found a significant association in the opposite direction, with units M a n u s c r i p t / hospitals with more staff having higher rates of pressure ulcers (Cho et al, 2003, Twigg et al, 2013. Nine studies explored associations with drug administration errors of which three showed low staffing to be significantly associated with higher rates of errors (Frith et al, 2012, Patrician et al, 2011.…”

“…A number of these studies found an association between a nursing skill mix that has a higher proportion of RNs and better outcomes including lower mortality / failure to rescue (Blegen et al, 2011, Estabrooks et al, 2005, lower rates of infections (Blegen et al, 2011, Cho et al, 2003, McGillis Hall et al, 2004, falls (Blegen and Vaughn, 1998, Donaldson et al, 2005, Patrician et al, 2011, pressure ulcers (Blegen et al, 2011, Ibe et al, 2008, and higher patient satisfaction (Potter et al, 2003). The overall pattern of results is largely consistent, with the only significant contradictory evidence coming from one of the weaker studies which showed that a higher proportion of registered nurses was associated with a higher nurse reported incidence of pneumonia (Ausserhofer et al, 2013).…”

“…A number of studies we reviewed, including some of relatively high quality (e.g. Cho et al, 2003), found that hospitals or wards with higher levels of nurse staffing had higher rates of pressure ulcers. That higher levels of nurse staffing should be the cause of the higher rates seems initially implausible (although such explanations should not always be dismissed out of hand).…”

The impact of nurses on patient morbidity and mortality - the need for a policy change in response to the nursing shortage

“…This constituted a considerable saving compared to the cost of thrombolytic therapy in acute myocardial infarction at US$182 000 per life saved or routine cervical cancer screening at a cost of US$432 000 per life saved. Similarly, Cho 26 has found the costs of hospital-acquired pneumonia to be US$22 390-$28 505 per episode. These studies [23][24][25][26] clearly support the proposition that to increase RN hours of care is cost effective as it improves patient outcomes but is also affordable.…”