2.50
Hdl Handle:
http://hdl.handle.net/10755/150206
Type:
Presentation
Title:
Nurse Staffing and Quality of Care in Acute Care Hospitals
Abstract:
Nurse Staffing and Quality of Care in Acute Care Hospitals
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Buerhaus, Peter, PhD
P.I. Institution Name:Vanderbilt University
Title:
Research Objective: Identify patient outcomes associated with nurse staffing in acute care hospitals that can be used to track the impact of staffing levels and staffing changes over time and across facilities. Test the impact of outcomes using (1) staffing data at the hospital versus inpatient unit level, and (2) Medicate only versus all-patient data. Study Design: Outcomes potentially sensitive to nurse staffing were identified and coding rules for hospital discharge abstracts established for: urinary tract infection, skin pressure ulcers pneumonia, deep venous thrombosis, upper gastrointestinal (UGI) bleeding, central nervous system complications, sepsis, shock, wound infection, pulmonary failure, metabolic derangement, length of stay, death and failure to rescue. Counts of these outcomes in medical and surgical patients were regressed on hospital nurse staffing controlling for patient risk and other variables. In addition, results from hospital level estimates of nurse staffing were compared to results using unit-level data, and results for models using only Medicare patients were compared to results using data on all patients. Population Studied: Patient discharge and hospital nurse staffing data from 799 hospitals in 11 states, and Medicare discharge data and nurse staffing data from a national sample of 3,357 hospitals. Principal Findings: Our analysis finds a strong and consistent association between staffing and four outcomes in medical patients – length of stay, urinary tract infections, pneumonia, UGI bleeding and shock/cardiac arrest – and one in major surgery patients – failure to rescue. Weaker associations were found for the other outcomes. The relationship between nurse staffing and outcomes is complex. Both number of hours and mix of personnel matter, with significant interactions between level and skill mix variables. In simulations, moving from low to high RN staffing was associated with a 3 to 12 percent reduction in the rates of these outcomes, and moving from low to high values for all nurse staffing variables was associated with a 2 to 25 percent reduction in outcomes, depending on the outcome and regression model used. Results from models using unit level data are consistent with those using hospital level data. Results from the analysis of Medicare patients are consistent with those from the all patient sample for medical patients, but some differences are observed for outcomes in major surgery patients. Conclusion: The analysis provides evidence that certain patient outcomes are clearly associated with nurse staffing, and particularly with RN staffing. The effect of staffing variation on these measures, taken as a group and considering frequency of the events, is substantial. Whether unit level data allow better estimation of these associations requires further analysis with a larger sample. It appears reasonable to use national Medicare data to assess patient outcomes in lieu of all-patient data, but further analysis is needed to understand differences in surgical patients between the national Medicare sample and state all patient sample.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleNurse Staffing and Quality of Care in Acute Care Hospitalsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/150206-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Nurse Staffing and Quality of Care in Acute Care Hospitals</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Buerhaus, Peter, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Vanderbilt University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value"> </td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">peter.buerhaus@mcmail.vanderbi</td></tr><tr><td colspan="2" class="item-abstract">Research Objective: Identify patient outcomes associated with nurse staffing in acute care hospitals that can be used to track the impact of staffing levels and staffing changes over time and across facilities. Test the impact of outcomes using (1) staffing data at the hospital versus inpatient unit level, and (2) Medicate only versus all-patient data. Study Design: Outcomes potentially sensitive to nurse staffing were identified and coding rules for hospital discharge abstracts established for: urinary tract infection, skin pressure ulcers pneumonia, deep venous thrombosis, upper gastrointestinal (UGI) bleeding, central nervous system complications, sepsis, shock, wound infection, pulmonary failure, metabolic derangement, length of stay, death and failure to rescue. Counts of these outcomes in medical and surgical patients were regressed on hospital nurse staffing controlling for patient risk and other variables. In addition, results from hospital level estimates of nurse staffing were compared to results using unit-level data, and results for models using only Medicare patients were compared to results using data on all patients. Population Studied: Patient discharge and hospital nurse staffing data from 799 hospitals in 11 states, and Medicare discharge data and nurse staffing data from a national sample of 3,357 hospitals. Principal Findings: Our analysis finds a strong and consistent association between staffing and four outcomes in medical patients &ndash; length of stay, urinary tract infections, pneumonia, UGI bleeding and shock/cardiac arrest &ndash; and one in major surgery patients &ndash; failure to rescue. Weaker associations were found for the other outcomes. The relationship between nurse staffing and outcomes is complex. Both number of hours and mix of personnel matter, with significant interactions between level and skill mix variables. In simulations, moving from low to high RN staffing was associated with a 3 to 12 percent reduction in the rates of these outcomes, and moving from low to high values for all nurse staffing variables was associated with a 2 to 25 percent reduction in outcomes, depending on the outcome and regression model used. Results from models using unit level data are consistent with those using hospital level data. Results from the analysis of Medicare patients are consistent with those from the all patient sample for medical patients, but some differences are observed for outcomes in major surgery patients. Conclusion: The analysis provides evidence that certain patient outcomes are clearly associated with nurse staffing, and particularly with RN staffing. The effect of staffing variation on these measures, taken as a group and considering frequency of the events, is substantial. Whether unit level data allow better estimation of these associations requires further analysis with a larger sample. It appears reasonable to use national Medicare data to assess patient outcomes in lieu of all-patient data, but further analysis is needed to understand differences in surgical patients between the national Medicare sample and state all patient sample.</td></tr></table>en_GB
dc.date.available2011-10-26T10:18:56Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T10:18:56Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.