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 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.

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Chronic hospital nurse understaffing meets COVID-19: an observational study

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-011512 ◽

2020 ◽

pp. bmjqs-2020-011512 ◽

Cited By ~ 3

Author(s):

Karen B Lasater ◽

Linda H Aiken ◽

Douglas M Sloane ◽

Rachel French ◽

Brendan Martin ◽

...

Keyword(s):

New York ◽

Patient Outcomes ◽

Nurse Staffing ◽

Care Quality ◽

Additional Patient ◽

Hospital Nurses ◽

The Public ◽

Hospital Nurse ◽

Local Evidence ◽

Surgical Units

IntroductionEfforts to enact nurse staffing legislation often lack timely, local evidence about how specific policies could directly impact the public’s health. Despite numerous studies indicating better staffing is associated with more favourable patient outcomes, only one US state (California) sets patient-to-nurse staffing standards. To inform staffing legislation actively under consideration in two other US states (New York, Illinois), we sought to determine whether staffing varies across hospitals and the consequences for patient outcomes. Coincidentally, data collection occurred just prior to the COVID-19 outbreak; thus, these data also provide a real-time example of the public health implications of chronic hospital nurse understaffing.MethodsSurvey data from nurses and patients in 254 hospitals in New York and Illinois between December 2019 and February 2020 document associations of nurse staffing with care quality, patient experiences and nurse burnout.ResultsMean staffing in medical-surgical units varied from 3.3 to 9.7 patients per nurse, with the worst mean staffing in New York City. Over half the nurses in both states experienced high burnout. Half gave their hospitals unfavourable safety grades and two-thirds would not definitely recommend their hospitals. One-third of patients rated their hospitals less than excellent and would not definitely recommend it to others. After adjusting for confounding factors, each additional patient per nurse increased odds of nurses and per cent of patients giving unfavourable reports; ORs ranged from 1.15 to 1.52 for nurses on medical-surgical units and from 1.32 to 3.63 for nurses on intensive care units.ConclusionsHospital nurses were burned out and working in understaffed conditions in the weeks prior to the first wave of COVID-19 cases, posing risks to the public’s health. Such risks could be addressed by safe nurse staffing policies currently under consideration.

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Evidence on Nurse Staffing Ratios and Patient Outcomes in a Low‐Income Country: Implications for Future Research and Practice

Worldviews on Evidence-Based Nursing ◽

10.1111/wvn.12316 ◽

2018 ◽

Vol 15 (5) ◽

pp. 353-360 ◽

Cited By ~ 9

Author(s):

Iman Al Kouatly ◽

Nada Nassar ◽

Maya Nizam ◽

Lina Kurdahi Badr

Keyword(s):

Patient Outcomes ◽

Low Income ◽

Nurse Staffing ◽

Income Country ◽

Future Research ◽

Research And Practice ◽

Staffing Ratios ◽

Low Income Country

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How space design and technology can support the Pharmacy Practice Model Initiative through interprofessional collaboration

INNOVATIONS in pharmacy ◽

10.24926/iip.v5i3.355 ◽

2014 ◽

Vol 5 (3) ◽

Author(s):

Lindsay Hahn ◽

Martha Buckner ◽

Georgeann B. Burns ◽

Debbie Gregory

Keyword(s):

Patient Outcomes ◽

Interprofessional Collaboration ◽

Pharmacy Practice ◽

Cost Savings ◽

Pharmacist Intervention ◽

Direct Patient Care ◽

Design And Technology ◽

Bottom Line ◽

Practice Model ◽

Space Design

Purpose: The Pharmacy Practice Model Initiative (PPMI) calls pharmacists to more direct patient care and increased responsibility for medication-related outcomes, as a means of achieving greater safety, improving outcomes and reducing costs. This article acknowledges the value of interprofessional collaboration to the PPMI and identifies the implications of the Initiative for space design and technology, both of which stand to help the Initiative gather additional support. Summary: The profession of pharmacy has for some time now become increasingly vocal about its desire to take on greater responsibility for patient outcomes. With drug costs representing the largest portion of a hospital's pharmacy budget and reimbursements becoming more contingent on readmission avoidance, the pharmacy's influence on a hospital's bottom line is significant. More importantly, study after study is showing that with greater pharmacist intervention, patient outcomes improve. This article addresses the ways in which developments in the fields of technology and facility design can assist in the deployment of the PPMI. Conclusion: As the PPMI achieves a critical level of support from inside and outside the pharmacy, and more empirical research emerges regarding the improved outcomes and cost savings of increasing the roles of both clinical pharmacists and pharmacy technicians, the industry sectors of healthcare technology and healthcare design stand ready to assist in the execution of this new model. By encouraging pharmacists, doctors and nurses to work together - and all caregivers to work with facility designers, biomedical engineers and IT specialists, there is the increased likelihood of these fields turning to each other to problem-solve together, all for the ultimate benefit to patients and their families. Type: Commentary

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Albuterol Use in Children Hospitalized with Human Metapneumovirus Respiratory Infection

International Journal of Pediatrics ◽

10.1155/2016/7021943 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Lindsey K. Rasmussen ◽

Jennifer Schuette ◽

Michael C. Spaeder

Keyword(s):

Length Of Stay ◽

Patient Outcomes ◽

Respiratory Infection ◽

Medical Condition ◽

Tertiary Care ◽

Human Metapneumovirus ◽

Hospital Length Of Stay ◽

Additional Patient ◽

Chronic Medical Condition ◽

Hmpv Infection

Introduction. Human metapneumovirus (HMPV) is a paramyxovirus from the same subfamily as respiratory syncytial virus (RSV) and causes similar acute lower respiratory tract infection. Albuterol in the setting of acute RSV infection is controversial and has not yet been studied in HMPV. We sought to determine the frequency of albuterol use in HMPV infection and the association between albuterol administration and patient outcomes.Methods. We conducted a retrospective cohort study identifying all patients hospitalized in a tertiary care children’s hospital with laboratory-confirmed HMPV infection between January 2010 and December 2010.Results. There were 207 patients included in the study; 57% had a chronic medical condition. The median hospital length of stay was 3 days. Only 31% of patients in the study had a documented wheezing history, while 69% of patients received at least one albuterol treatment. There was no difference in length of stay between patients who received albuterol and those who did not.Conclusion. There is a high frequency of albuterol use in children hospitalized with HMPV infection. As with RSV, evidence may not support routine use of bronchodilators in patients with acute HMPV respiratory infection. Research involving additional patient outcomes and illness severity indicators would be useful in future studies.

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Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Journal of Hospital Medicine ◽

10.12788/jhm.3363 ◽

2020 ◽

pp. 232-235

Author(s):

Nidhi Rohatgi ◽

Yingjie Weng ◽

Neera Ahuja

Keyword(s):

Internal Medicine ◽

Regression Analysis ◽

Length Of Stay ◽

Patient Outcomes ◽

Cost Savings ◽

Rapid Response Team ◽

Medical Complication ◽

Surgical Services ◽

Response Team ◽

Yearly Change

Neurosurgery services in which the same Internal Medicine hospitalists are dedicated year round to each of these surgical services to proactively prevent and manage medical conditions. In this article, we evaluate if SCM was associated with continued improvement in patient outcomes between 2012 and 2018 in Orthopedic and Neurosurgery services at our institution. We conducted regression analysis on 26,380 discharges to assess yearly change in our outcomes. Since 2012, the odds of patients with ≥1 medical complication decreased by 3.8% per year (P = .01), the estimated length of stay decreased by 0.3 days per year (P < .0001), and the odds of rapid response team calls decreased by 12.2% per year (P = .001). Estimated average direct cost savings were $3,424 per discharge.

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