Nurse Staffing and Patient Care Costs in Acute Inpatient Nursing Units

Li, Yu Fang; Wong, Edwin S.; Sales, Anne E.; Sharp, Nancy; Needleman, Jack; Maciejewski, Matthew L.; Lowy, Elliott; Alt-White, Anna C.; Liu, Chuan Fen

doi:10.1097/mlr.0b013e318223a9f1

Cited by 15 publications

(27 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The better patient outcomes associated in this study with richer skill mix suggest that, as in the USA where detailed cost information is available, fewer expensive complications like infection, shorter length of stay and fewer intensive care unit days among patients in hospitals with better professional nurse staffing would likely offset higher labour costs associated with richer skill mix and return good value to health systems. 26 Our results of one of the first comprehensive studies of nursing skill mix in Europe are similar to results obtained in studies of nursing skill mix in the USA. Our four state study in the USA showed 30-day general surgery mortality rates of 1.2% 32 compared with European in-hospital mortality rates shown here of 1.28%; the US patients studied included all adult patients aged 20-85 years while the European patients were aged 50 years and older.…”

Section: Discussionsupporting

confidence: 84%

“…[21][22][23][24] The US studies have generally concluded that a hospital skill mix with proportionately more professional nurses yields greater value because higher wages of professional nurses are offset by reductions in length of stay, lower use of intensive care, fewer costly adverse events such as hospital-acquired infections and lower readmission rates. [25][26][27][28][29] Needleman et al estimated that holding constant the total number of hours of nursing care provided, replacing lower qualified licensed practical nurses with fewer years of education with professional nurses would result in lower hospital mortality, shorter length of stay, fewer complications and net savings. 30 The aim of this paper is to inform managerial and policy decision-making about hospital nursing skill mix in Europe through an analysis of the association between nursing skill mix and patient mortality, patient ratings of their care and quality of care indicators in hospitals in six European countries: Belgium, England, Finland, Ireland, Spain and Switzerland.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

et al. 2016

View full text Add to dashboard Cite

ObjectivesTo determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care.DesignCross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models.SettingAdult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland.ParticipantsSurvey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals.Main outcome measuresPatient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction.ResultsRicher nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

et al. 2016

View full text Add to dashboard Cite

show abstract

“…2009, Li et al . 2011, Weiss et al . 2011), one was a meta-analysis of observational studies (Kane et al .…”

Section: Resultsmentioning

confidence: 99%

“…Li et al . (2011) estimated the contribution of nursing costs to inpatient costs to calculate the change in cost for a one unit change in the staffing variable.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Is there an economic case for investing in nursing care – what does the literature tell us?

Twigg

Myers

Duffield

et al. 2014

Journal of Advanced Nursing

View full text Add to dashboard Cite

AimTo determine the cost effectiveness of increasing nurse staffing or changing the nursing skill mix in adult medical and/or surgical patients?BackgroundResearch has demonstrated that nurse staffing levels and skill mix are associated with patient outcomes in acute care settings. If increased nurse staffing levels or richer skill mix can be shown to be cost-effective hospitals may be more likely to consider these aspects when making staffing decisions.DesignA systematic review of the literature on economic evaluations of nurse staffing and patient outcomes was conducted to see whether there is consensus that increasing nursing hours/skill mix is a cost-effective way of improving patient outcomes. We used the Cochrane Collaboration systematic review method incorporating economic evidence.Data sourcesThe MEDLINE, CINAHL, SPORTDiscus and PsychINFO databases were searched in 2013 for published and unpublished studies in English with no date limits.Review methodsThe review focused on full economic evaluations where costs of increasing nursing hours or changing the skill mix were included and where consequences included nursing sensitive outcomes.ResultsFour-cost benefit and five-cost effectiveness analyses were identified. There were no cost-minimization or cost-utility studies identified in the review. A variety of methods to conceptualize and measure costs and consequences were used across the studies making it difficult to compare results.ConclusionThis review was unable to determine conclusively whether or not changes in nurse staffing levels and/or skill mix is a cost-effective intervention for improving patient outcomes due to the small number of studies, the mixed results and the inability to compare results across studies.

show abstract

Evaluating the Costs and Outcomes of Hospital Nursing Resources: a Matched Cohort Study of Patients with Common Medical Conditions

et al. 2020

View full text Add to dashboard Cite

BACKGROUND: Nursing resources, such as staffing ratios and skill mix, vary across hospitals. Better nursing resources have been linked to better patient outcomes but are assumed to increase costs. The value of investments in nursing resources, in terms of clinical benefits relative to costs, is unclear. OBJECTIVE: To determine whether there are differential clinical outcomes, costs, and value among medical patients at hospitals characterized by better or worse nursing resources. DESIGN: Matched cohort study of patients in 306 acute care hospitals. PATIENTS: A total of 74,045 matched pairs of fee-forservice Medicare beneficiaries admitted for common medical conditions (25,446 sepsis pairs; 16,332 congestive heart failure pairs; 12,811 pneumonia pairs; 10,598 stroke pairs; 8858 acute myocardial infarction pairs). Patients were also matched on hospital size, technology, and teaching status. MAIN MEASURES: Better (n = 76) and worse (n = 230) nursing resourced hospitals were defined by patient-tonurse ratios, skill mix, proportions of bachelors-degree nurses, and nurse work environments. Outcomes included 30-day mortality, readmission, and resource utilization-based costs. KEY RESULTS: Patients in hospitals with better nursing resources had significantly lower 30-day mortality (16.1% vs 17.1%, p < 0.0001) and fewer readmissions (32.3% vs 33.6%, p < 0.0001) yet costs were not significantly different ($18,848 vs 18,671, p = 0.133). The greatest outcomes and cost advantage of better nursing resourced hospitals were in patients with sepsis who had lower mortality (25.3% vs 27.6%, p < 0.0001). Overall, patients with the highest risk of mortality on admission experienced the greatest reductions in mortality and readmission from better nursing at no difference in cost. CONCLUSIONS: Medicare beneficiaries with common medical conditions admitted to hospitals with better nursing resources experienced more favorable outcomes at almost no difference in cost.

show abstract

Nurse Staffing and Patient Care Costs in Acute Inpatient Nursing Units

Abstract: The association of nurse staffing level with costs per admission differed for medical versus surgical admissions.

Cited by 15 publications

References 18 publications

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

Is there an economic case for investing in nursing care – what does the literature tell us?

Evaluating the Costs and Outcomes of Hospital Nursing Resources: a Matched Cohort Study of Patients with Common Medical Conditions

Contact Info

Product

Resources

About