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

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...

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Vydané v:BMJ open Ročník 11; číslo 12; s. e052899
Hlavní autori: Lasater, Karen B, Aiken, Linda H, Sloane, Douglas, French, Rachel, Martin, Brendan, Alexander, Maryann, McHugh, Matthew D
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England British Medical Journal Publishing Group 08.12.2021
BMJ Publishing Group LTD
BMJ Publishing Group
Edícia:Original research
Predmet:
Aged
Clinical outcomes
Cost control
Cost Savings
Cross-Sectional Studies
Data collection
health & safety
health policy
health services administration & management
Hospitals
Humans
Legislation
Length of stay
Medicare
Mortality
Nurses
Nursing
Nursing Staff, Hospital
Observational studies
organisation of health services
Patients
Personnel Staffing and Scheduling
quality in health care
Quality of Health Care
Ratios
Response rates
Sepsis
United States
Workforce
Workforce planning
Workloads
United States
New York
California
United States > US
Illinois
health policy
organisation of health services
quality in health care
health & safety
health services administration & management
ISSN:2044-6055, 2044-6055
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Shrnutí: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.
Bibliografia:Original research
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SourceType-Scholarly Journals-1
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ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2021-052899