The impact of the nursing hours per patient day (NHPPD) staffing method on patient outcomes: A retrospective analysis of patient and staffing data

Abstract

BackgroundIn March 2002 the Australian Industrial Relations Commission ordered the introduction of a new staffing method -nursing hours per patient day (NHPPD) -for implementation in Western Australia public hospitals. This method used a "bottom up" approach to classify each hospital ward into one of seven categories using characteristics such as patient complexity, intervention levels, the presence of high dependency beds, the emergency/elective patient mix and patient turnover. Once classified, NHPPD were allocated for each ward. ObjectivesThe objective of this study was to determine the impact of implementing the NHPPD staffing method on 14 nursing-sensitive outcomes: central nervous system complications, wound infections, pulmonary failure, urinary tract infection, pressure ulcer, pneumonia, deep vein thrombosis, ulcer/gastritis/upper gastrointestinal bleed, sepsis, physiologic/metabolic derangement, shock/cardiac arrest, mortality, failure to rescue and length of stay. Design and settingThe research design was an interrupted time series using retrospective analysis of patient and staffing administrative data from three adult tertiary hospitals in metropolitan Perth over a 4-year period. SampleAll patient records (N = 236,454) and nurse staffing records (N = 150,925) from NHPPD wards were included. ResultsThe study found significant decreases in the rates of nine nursing-sensitive outcomes when examining hospital-level data following implementation of NHPPD; mortality, central nervous system complications, pressure ulcers, deep vein thrombosis, sepsis, ulcer/gastritis/upper gastrointestinal bleed shock/cardiac arrest, pneumonia and average length of stay. At the ward level, significant decreases in the rates of five nursing-sensitive outcomes; mortality, shock/cardiac arrest, ulcer/gastritis/upper gastrointestinal bleed, length of stay and urinary tract infections occurred. ConclusionsThe findings provide evidence to support the continuation of the NHPPD staffing method. They also add to evidence about the importance of nurse staffing to patient safety; evidence that must influence policy. This study is one of the first to empirically review a specific nurse staffing method, based on an individual assessment of each ward to determine staffing requirements, rather than a "one-size-fits-all" approach.What is already known about the topic?• Higher nurse staffing levels have been linked with improved patient outcomes.• This evidence has resulted in some states and jurisdictions legislating or mandating nurse staffing.• The available evidence does not provide specific guidelines for nurse staffing, either in terms of the amount of care required or skill mix of the nurses providing care at a unit level. What this paper adds• This study empirically reviews a specific nurse staffing method, based on an individual assessment of each ward to determine staffing requirements, rather than a "one-size-fits-all" approach.• It provides evidence that implementation of the NHPPD staffing method decreased nursingsensi...

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Flexible nurse staffing based on hourly bed census predictions

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