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.

Adaptive staff scheduling at Outpatient Department of Ntaja Health Center in Malawi - A queuing theory application

Accurate staff scheduling is crucial in overcoming the problem of mismatch between staffing ratios and demand for health services which can impede smooth patient flow. Patient flow is an important process towards provision of improved quality of service and also improved utilization of hospital resources. However, extensive waiting times remains a key source of dissatisfaction with the quality of health care service among patients. With rarely scheduled hospital visits, the in-balance between hospital staffing and health service demand remains a constant challenge in Sub-Saharan Africa. Accurate workload predictions help anticipate financial needs and also aids in strategic planning for the health facility. Using a local health facility for a case study, we investigate problems faced by hospital management in staff scheduling. We apply queuing theory techniques to assess and evaluate the relationship between staffing ratios and waiting times at the facility. Specifically, using patient flow data for a rural clinic in Malawi, we model queue parameters and also approximate recommended staffing ratios to achieve steady state leading to reduced waiting times and consequently, improved service delivery at the clinic.

Professional Lactation Support Staffing in the Hospital Setting

An exploration of optimal hospital IBCLCs staffing ratios is needed to validate historical recommendations and promote positive breastfeeding outcomes.

Investigation of population-based mental health staffing and efficiency-based mental health productivity using an information-theoretic approach

Background Healthcare systems monitor and improve mental health treatment quality, access, continuity and satisfaction through use of population-based and efficiency-based staffing models, the former focused on staffing ratios and the latter, staff productivity. Preliminary evidence suggests that both high staffing ratios and moderate-to-high staff productivity are important for ensuring a full continuum of mental health services to indicated populations. Methods & findings With an information-theoretic approach, we conducted a longitudinal investigation of mental health staffing, productivity and treatment at the largest integrated healthcare system in American, the Veterans Health Administration (VHA). VHA facilities (N = 140) served as the unit of measure, with mental health treatment quality, access, continuity and satisfaction predicted by facility staffing and productivity in longitudinal mixed models. An information-theoretic approach: (a) entails the development of a comprehensive set of plausible models that are fit, ranked and weighted to quantitatively assess the relative support for each, and (b) accounts for model uncertainty while identifying best-fit model(s) that include important and exclude unimportant explanatory variables. In best-fit models, higher staffing was the strongest and most consistent predictor of better treatment quality, access, continuity and satisfaction. Higher staff productivity was often, but not always associated with better treatment quality, access, continuity and satisfaction. Results were further nuanced by differential prediction of treatment by between- and within-facility predictor effects and variable interactions. Conclusions A population-based mental health staffing ratio and an efficiency-based productivity value are important longitudinal predictors of mental health treatment quality, access, continuity and satisfaction. Our longitudinal design and use of mixed regression models and an information-theoretic approach addresses multiple limitations of prior studies and strengthen our results. Results are discussed in terms of the provision of mental health treatment by healthcare systems, and analytical modeling of treatment quality, access, continuity and satisfaction.

Technical Staffing Ratios: A Summary of 3 College of American Pathologists Q-Probes Studies

Context.— Laboratory managers and medical directors are charged with staffing their clinical laboratories as efficiently as possible. Objective.— To report and analyze the results of 3 College of American Pathologists Q-Probes studies that surveyed the normative rates of laboratory technical staffing ratios. Design.— Participants in the College of American Pathologists Q-Probes program submitted data on the levels of staffing and test volumes performed in their laboratories in 2014, 2016, and 2019. From these data, we calculated departmental productivity ratios, defined as testing volume per full-time equivalent, and degrees of managerial oversight, defined as the ratio of nonmanagement to management full-time equivalents. Participants completed general questionnaires surveying their hospital and laboratory demographics and practices, the data from which we determined demographic and practice characteristics that were significantly associated with technical staffing ratios. Results.— Sixty-seven, 82, and 79 institutions submitted data for the years 2019, 2016, and 2014, respectively. Technical staffing ratios varied widely among the various laboratory departments within each institution and among different institutions participating in this study. With the exception of cytology departments, productivity and managerial oversight ratios did not significantly change between these 3 studies. In the 2019 study, greater testing volumes were associated with higher productivity ratios. Significant associations between managerial oversight ratios and practice characteristics were not consistent across the 3 studies. Conclusions.— Technical staffing ratios varied widely among the various laboratory departments within each institution and among different institutions participating in this study.

Regional Cerebral Blood Perfusion Changes in Chronic Stroke Survivors as Potential Brain Correlates of The Functional Outcome Following Gamified Home-Based Rehabilitation (IntelliRehab)

Background: Hospital-based stroke rehabilitation for stroke survivors in developing countries may be limited by staffing ratios and length of stay that could hamper recovery potential. Thus, a home-based, gamified rehabilitation system (i.e. IntelliRehab) was tested for its ability to increase cerebral blood flow (CBF), and the secondary impact of changes on the upper limb motor function and functional outcomes. Objective: To explore the effect of IntelliRehab on CBF in chronic stroke patients and its correlation with the upper limb motor function. Methods: Two-dimensional pulsed Arterial Spin Labelling (2D-pASL) was used to obtain CBF images of stable, chronic stroke subjects (n=8) over 3-months intervention period. CBF alterations were mapped and the detected differences were marked as regions of interest. Motor functions represented by Fugl-Meyer Upper Extremity Assessment (FMA) and Stroke Impact Scale (SIS) were used to assess the primary and secondary outcomes, respectively. Results: Regional CBF were significantly increased in right inferior temporal gyrus and left superior temporal white matter after 1-month (p=0.044) and 3-months (p=0.01) of rehabilitation, respectively. However, regional CBF in left middle fronto-orbital gyrus significantly declined after 1-month of rehabilitation (p=0.012). Moreover, SIS-Q7 and FMA scores significantly increased after 1-month and 3-months of rehabilitation. There were no significant correlations, however, between CBF changes and upper limb motor function. Conclusions: Participants demonstrated improved motor functions, supporting the benefit of using IntelliRehab as a tool for home-based rehabilitation. However, the chronic nature of the stroke in recruited subjects may have limited potential for within-participant improvements.