scholarly journals PCV127 INCREASING NURSE STAFFING LEVELS IN BELGIAN CARDIAC SURGERY CENTERS: A COST-EFFECTIVE PATIENT SAFETY INTERVENTION?

2010 ◽  
Vol 13 (7) ◽  
pp. A365
Author(s):  
K Van den Heede ◽  
S Simoens ◽  
A Vleugels ◽  
W Sermeus
Keyword(s):  
Patient Safety ◽  
Cardiac Surgery ◽  
Nurse Staffing ◽  
Cost Effective ◽  
Staffing Levels ◽  
Safety Intervention

Increasing nurse staffing levels in Belgian cardiac surgery centres: a cost-effective patient safety intervention?

2010 ◽  
Vol 66 (6) ◽  
pp. 1291-1296 ◽  
Author(s):  
Koen Van den Heede ◽  
Steven Simoens ◽  
Luwis Diya ◽  
Emmanuel Lesaffre ◽  
Arthur Vleugels ◽  
...  
Keyword(s):  
Patient Safety ◽  
Cardiac Surgery ◽  
Nurse Staffing ◽  
Cost Effective ◽  
Staffing Levels ◽  
Safety Intervention

scholarly journals Costs and consequences of using average demand to plan baseline nurse staffing levels: a computer simulation study

2020 ◽  
Vol 30 (1) ◽  
pp. 7-16 ◽  
Author(s):  
Christina Saville ◽  
Thomas Monks ◽  
Peter Griffiths ◽  
Jane Elisabeth Ball
Keyword(s):  
Computer Simulation ◽  
Patient Safety ◽  
Quality Of Care ◽  
Nurse Staffing ◽  
Staffing Levels ◽  
Modelling Studies ◽  
Permanent Staff ◽  
Temporary Staffing ◽  
The Cost

BackgroundPlanning numbers of nursing staff allocated to each hospital ward (the ‘staffing establishment’) is challenging because both demand for and supply of staff vary. Having low numbers of registered nurses working on a shift is associated with worse quality of care and adverse patient outcomes, including higher risk of patient safety incidents. Most nurse staffing tools recommend setting staffing levels at the average needed but modelling studies suggest that this may not lead to optimal levels.ObjectiveUsing computer simulation to estimate the costs and understaffing/overstaffing rates delivered/caused by different approaches to setting staffing establishments.MethodsWe used patient and roster data from 81 inpatient wards in four English hospital Trusts to develop a simulation of nurse staffing. Outcome measures were understaffed/overstaffed patient shifts and the cost per patient-day. We compared staffing establishments based on average demand with higher and lower baseline levels, using an evidence-based tool to assess daily demand and to guide flexible staff redeployments and temporary staffing hires to make up any shortfalls.ResultsWhen baseline staffing was set to meet the average demand, 32% of patient shifts were understaffed by more than 15% after redeployment and hiring from a limited pool of temporary staff. Higher baseline staffing reduced understaffing rates to 21% of patient shifts. Flexible staffing reduced both overstaffing and understaffing but when used with low staffing establishments, the risk of critical understaffing was high, unless temporary staff were unlimited, which was associated with high costs.ConclusionWhile it is common practice to base staffing establishments on average demand, our results suggest that this may lead to more understaffing than setting establishments at higher levels. Flexible staffing, while an important adjunct to the baseline staffing, was most effective at avoiding understaffing when high numbers of permanent staff were employed. Low staffing establishments with flexible staffing saved money because shifts were unfilled rather than due to efficiencies. Thus, employing low numbers of permanent staff (and relying on temporary staff and redeployments) risks quality of care and patient safety.

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

2010 ◽  
Vol 34 (3) ◽  
pp. 312 ◽  
Author(s):  
Di Twigg ◽  
Christine Duffield ◽  
Peter L. Thompson ◽  
Pat Rapley
Keyword(s):  
Patient Safety ◽  
Health System ◽  
Registered Nurses ◽  
Patient Outcomes ◽  
Registered Nurse ◽  
Nurse Staffing ◽  
Cost Effective ◽  
Shared Responsibility ◽  
Policy Response ◽  
Policy Makers

Context.Workforce projections indicate that by 2012 there will be a shortfall of 61 000 registered nurses in Australia. There is a growing body of evidence that links registered nurse staffing to better patient outcomes. Purpose.This article provides a comprehensive review of the research linking nurse staffing to patient outcomes at a time of growing shortages, highlighting that a policy response based on substituting registered nurses with lower skilled workers may have adverse effects on patient outcomes. Method.An electronic search of articles published in English using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Journals @ OVID and Medline was undertaken. Findings.Robust evidence exists nationally and internationally that links nurse staffing to patient outcomes. Recent meta-analyses have found that there was a 3–12% reduction in adverse outcomes and a 16% reduction in the risk of mortality in surgical patients with higher registered nurse staffing. Evidence confirms that improvements in nurse staffing is a cost-effective investment for the health system but this is not fully appreciated by health policy advisors. Conclusions.An appropriate policy response demands that the evidence that patient safety is linked to nurse staffing be recognised. Policy makers must ensure there are sufficient registered nurses to guarantee patient safety. What is known about the topic?Projections indicate that by 2012 there will be an estimated shortfall of 61 000 registered nurses in Australia. However, research demonstrates the number of registered nurses caring for patients is critically important to prevent adverse patient outcomes. Evidence also confirms that improvements in nurse staffing is a cost-effective investment for the health system. What this paper adds?The paper exposes the lack of an appropriate policy response to the evidence in regard to nurse staffing and patient outcomes. It argues that patient safety must be recognised as a shared responsibility between policy makers and the nursing profession. What are the implications for practitioners?Policy makers, health departments, Chief Executives and Nurse Leaders need to ensure that adequate nurse staffing includes a high proportion of registered nurses to prevent adverse patient outcomes.

scholarly journals The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study

2020 ◽  
Vol 8 (16) ◽  
pp. 1-162 ◽  
Author(s):  
Peter Griffiths ◽  
Christina Saville ◽  
Jane E Ball ◽  
Rosemary Chable ◽  
Andrew Dimech ◽  
...  
Keyword(s):  
Nursing Care ◽  
Response Rate ◽  
Nurse Staffing ◽  
Cost Savings ◽  
Cost Effective ◽  
Staffing Levels ◽  
The Mean ◽  
Staffing Requirements ◽  
Hospital Wards ◽  
Professional Judgement

Background The Safer Nursing Care Tool is a system designed to guide decisions about nurse staffing requirements on hospital wards, in particular the number of nurses to employ (establishment). The Safer Nursing Care Tool is widely used in English hospitals but there is a lack of evidence about how effective and cost-effective nurse staffing tools are at providing the staffing levels needed for safe and quality patient care. Objectives To determine whether or not the Safer Nursing Care Tool corresponds to professional judgement, to assess a range of options for using the Safer Nursing Care Tool and to model the costs and consequences of various ward staffing policies based on Safer Nursing Care Tool acuity/dependency measure. Design This was an observational study on medical/surgical wards in four NHS hospital trusts using regression, computer simulations and economic modelling. We compared the effects and costs of a ‘high’ establishment (set to meet demand on 90% of days), the ‘standard’ (mean-based) establishment and a ‘flexible (low)’ establishment (80% of the mean) providing a core staff group that would be sufficient on days of low demand, with flexible staff re-deployed/hired to meet fluctuations in demand. Setting Medical/surgical wards in four NHS hospital trusts. Main outcome measures The main outcome measures were professional judgement of staffing adequacy and reports of omissions in care, shifts staffed more than 15% below the measured requirement, cost per patient-day and cost per life saved. Data sources The data sources were hospital administrative systems, staff reports and national reference costs. Results In total, 81 wards participated (85% response rate), with data linking Safer Nursing Care Tool ratings and staffing levels for 26,362 wards × days (96% response rate). According to Safer Nursing Care Tool measures, 26% of all ward-days were understaffed by ≥ 15%. Nurses reported that they had enough staff to provide quality care on 78% of shifts. When using the Safer Nursing Care Tool to set establishments, on average 60 days of observation would be needed for a 95% confidence interval spanning 1 whole-time equivalent either side of the mean. Staffing levels below the daily requirement estimated using the Safer Nursing Care Tool were associated with lower odds of nurses reporting ‘enough staff for quality’ and more reports of missed nursing care. However, the relationship was effectively linear, with staffing above the recommended level associated with further improvements. In simulation experiments, ‘flexible (low)’ establishments led to high rates of understaffing and adverse outcomes, even when temporary staff were readily available. Cost savings were small when high temporary staff availability was assumed. ‘High’ establishments were associated with substantial reductions in understaffing and improved outcomes but higher costs, although, under most assumptions, the cost per life saved was considerably less than £30,000. Limitations This was an observational study. Outcomes of staffing establishments are simulated. Conclusions Understanding the effect on wards of variability of workload is important when planning staffing levels. The Safer Nursing Care Tool correlates with professional judgement but does not identify optimal staffing levels. Employing more permanent staff than recommended by the Safer Nursing Care Tool guidelines, meeting demand most days, could be cost-effective. Apparent cost savings from ‘flexible (low)’ establishments are achieved largely by below-adequate staffing. Cost savings are eroded under the conditions of high temporary staff availability that are required to make such policies function. Future work Research is needed to identify cut-off points for required staffing. Prospective studies measuring patient outcomes and comparing the results of different systems are feasible. Trial registration Current Controlled Trials ISRCTN12307968. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 16. See the NIHR Journals Library website for further project information.

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