The impact of nurse staffing on falls performance within a health care system: A descriptive study

Cooke, Melissa; Fuente, Margarita de la; Stringfield, Candice; Sullivan, Kelly; Brassil, Robert; Thompson, Julie; Allen, Deborah H.; Granger, Bradi B.; Reynolds, Staci S.

doi:10.1111/jonm.13555

Cited by 8 publications

(5 citation statements)

References 21 publications

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“…Furthermore, hospital-acquired adverse events have been shown to be sensitive to staffing ratios and composition, specifically among nurses . Given that private equity firms have reduced staffing and changed the clinician labor mix at acquired hospitals and clinics, an analogous cost-cutting strategy in our sample may help explain the increase in hospital-acquired conditions.…”

Section: Discussionmentioning

confidence: 97%

Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition

Kannan,

Bruch,

Song

2023

JAMA

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ImportanceThe effects of private equity acquisitions of US hospitals on the clinical quality of inpatient care and patient outcomes remain largely unknown.ObjectiveTo examine changes in hospital-acquired adverse events and hospitalization outcomes associated with private equity acquisitions of US hospitals.Design, Setting, and ParticipantsData from 100% Medicare Part A claims for 662 095 hospitalizations at 51 private equity–acquired hospitals were compared with data for 4 160 720 hospitalizations at 259 matched control hospitals (not acquired by private equity) for hospital stays between 2009 and 2019. An event study, difference-in-differences design was used to assess hospitalizations from 3 years before to 3 years after private equity acquisition using a linear model that was adjusted for patient and hospital attributes.Main Outcomes and MeasuresHospital-acquired adverse events (synonymous with hospital-acquired conditions; the individual conditions were defined by the US Centers for Medicare &amp; Medicaid Services as falls, infections, and other adverse events), patient mix, and hospitalization outcomes (including mortality, discharge disposition, length of stay, and readmissions).ResultsHospital-acquired adverse events (or conditions) were observed within 10 091 hospitalizations. After private equity acquisition, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions compared with those treated at control hospitals (4.6 [95% CI, 2.0-7.2] additional hospital-acquired conditions per 10 000 hospitalizations, P = .004). This increase in hospital-acquired conditions was driven by a 27.3% increase in falls (P = .02) and a 37.7% increase in central line–associated bloodstream infections (P = .04) at private equity hospitals, despite placing 16.2% fewer central lines. Surgical site infections doubled from 10.8 to 21.6 per 10 000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume; meanwhile, such infections decreased at control hospitals, though statistical precision of the between-group comparison was limited by the smaller sample size of surgical hospitalizations. Compared with Medicare beneficiaries treated at control hospitals, those treated at private equity hospitals were modestly younger, less likely to be dually eligible for Medicare and Medicaid, and more often transferred to other acute care hospitals after shorter lengths of stay. In-hospital mortality (n = 162 652 in the population or 3.4% on average) decreased slightly at private equity hospitals compared with the control hospitals; there was no differential change in mortality by 30 days after hospital discharge.Conclusions and RelevancePrivate equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line–associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections. Shifts in patient mix toward younger and fewer dually eligible beneficiaries admitted and increased transfers to other hospitals may explain the small decrease in in-hospital mortality at private equity hospitals relative to the control hospitals, which was no longer evident 30 days after discharge. These findings heighten concerns about the implications of private equity on health care delivery.

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Section: Discussionmentioning

confidence: 97%

Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition

Kannan,

Bruch,

Song

2023

JAMA

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“…An explanation for this could be the unequal distribution of resources, such as staff, nurses, and equipment, among different shifts. This imbalance is likely to impact the occurrence of falls in each shift, as the availability and utilization of resources could affect patient safety and care quality [33] [34] [35]. The study found that medication involvement was closely related to fall risk levels during the morning shift, emphasizing the importance of investigating the type of medication involved.…”

Section: Discussionmentioning

confidence: 99%

An Inpatient Fall Risk Assessment Tool: Application of Machine Learning Models on Intrinsic and Extrinsic Risk Factors

Jahangiri

Abdollahi

Patil

et al. 2023

Preprint

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Purpose This study aimed to identify the most impactful set of intrinsic and extrinsic fall risk factors and develop a data-driven inpatient fall risk assessment tool (FRAT). Methods The dataset used for the study comprised in-hospital fall records from 2012 to 2017. Two machine learning (ML) algorithms, Support Vector Machine (SVM) and Random Forest (RF) were utilized to predict the inpatient fall risk level. To enhance the performance of the prediction models, two approaches were implemented, including (1) feature selection to identify the optimal feature set and (2) the development of three distinct shift-wise models. Furthermore, the optimal feature sets in the shift-wise models were extracted. Results According to the results, RF outperformed SVM by reaching an accuracy, sensitivity, specificity, and AUC of 0.66, 0.74, 0.59, and 0.73, respectively, considering the full set of features. The performance of the models was further improved (by 3%-5%) by conducting a feature selection process for both RF and SVM models. Specifically, the RF model achieved an accuracy of 0.69 while considering the optimal set of predictors. Moreover, the shift-wise RF models demonstrated higher accuracies (by 4%-10%) compared to the same model using a full feature set. Conclusion This study's outcome confirms ML models' compelling capability in developing an inpatient FRAT while considering intrinsic and extrinsic factors. The insight from such models could form a foundation to (1) monitor the inpatients’ fall risk, (2) identify the major factors involved in inpatient falls, and (3) create subject-specific self-care plans.

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“…Hospital-acquired adverse events have been shown to be sensitive to staffing ratios and staff composition. 8 Private equity firms are known to decrease staffing and staff skill mix upon acquisition to decrease cost. The results of this well-designed study should raise many questions regarding operational motives and clinical outcomes of private equity firm ownership of hospitals and outpatient centers.…”

Section: Quality Of Care In Hospitals Owned By Private Equity Firmsmentioning

confidence: 99%

“…Medicare beneficiaries treated at the private equity–owned hospitals experienced a reduction in discharges home of 0.6% compared with those treated at the control group hospitals. Hospital-acquired adverse events have been shown to be sensitive to staffing ratios and staff composition 8 . Private equity firms are known to decrease staffing and staff skill mix upon acquisition to decrease cost.…”

Section: Quality Of Care In Hospitals Owned By Private Equity Firmsmentioning

confidence: 99%

Private Equity Ownership in Healthcare

Scruth,

Martinez,

Worth

2024

Clin Nurse Spec

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The impact of nurse staffing on falls performance within a health care system: A descriptive study

Cited by 8 publications

References 21 publications

Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition

Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition

An Inpatient Fall Risk Assessment Tool: Application of Machine Learning Models on Intrinsic and Extrinsic Risk Factors

Private Equity Ownership in Healthcare

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