2.50
Hdl Handle:
http://hdl.handle.net/10755/159796
Type:
Presentation
Title:
Measures of Nurse Staffing and Failure to Rescue
Abstract:
Measures of Nurse Staffing and Failure to Rescue
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2009
Author:Vanderboom, Catherine, PhD, RN
P.I. Institution Name:Mayo Clinic
Contact Address:200 First Street SW, Stabile 11-77, Rochester, MN, 55905, USA
Contact Telephone:507-284-0360
Co-Authors:M. Harris, C. Vanderboom, , Mayo Clinic, Rochester, MN;
Background: The association of nurse staffing with quality outcomes remains a topic of high interest. Failure to Rescue (FTR) is a National Quality Forum (NQF) nursing-sensitive performance measure and proposed 2010 CMS quality measure. FTR uses inpatient billing data to identify hospital acquired complications that end in death. Six FTR complication types are defined; for each, a denominator is constructed by applying inclusion and exclusion rules to ICD-9-CM discharge diagnoses and the numerator is number of deaths. Among the challenges in analyzing nurse staffing and FTR rates is the way nurse staffing is measured. Moreover, the impact of nursing shortages is at the shift and unit level, however the majority of studies are based on hospital level data and are cross-sectional thus one cannot associate staffing with unique patient outcomes. Objective: This study links nurse staffing to specific patients, examines two measures of nurse staffing obtained at the unit and shift level, and their association with failure to rescue. Methods: We examined over 250,000 Mayo Clinic hospital discharges from 2003-2006. The failure to rescue measure was constructed using the methods published by the Agency for Healthcare Research and Quality. Staffing measures were based a method for acuity adjusting unit census to recommend staffing needs on a shift-to-shift basis. Staffing measures included actual hours and the gap between recommended and actual hours. Logistic regression was used to analyze the impact of nurse staffing on FTR. Results: Of 22,683 discharges that met criteria for the denominator, 20,108 had a discharge status of alive. Age, presence of any of the six complications and the interaction of complications with a gap in staffing were most predictive of FTR (p<.01). However different staffing measures exhibited different levels of significance within and across complication types. Conclusions: We have reported on a fully powered study of the effect of unit/shift level staffing on FTR. The specific measure of staffing affected the significance of the staffing variable in predicting FTR. Moreover, the impact of nurse staffing on FTR differed across the six FTR complication types. These findings have implications for studies of nursing sensitive outcomes.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Midwest Nursing Research Society

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleMeasures of Nurse Staffing and Failure to Rescueen_GB
dc.identifier.urihttp://hdl.handle.net/10755/159796-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Measures of Nurse Staffing and Failure to Rescue</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Midwest Nursing Research Society</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Vanderboom, Catherine, PhD, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Mayo Clinic</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">200 First Street SW, Stabile 11-77, Rochester, MN, 55905, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">507-284-0360</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">vanderboom.catherine@mayo.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">M. Harris, C. Vanderboom, , Mayo Clinic, Rochester, MN;</td></tr><tr><td colspan="2" class="item-abstract">Background: The association of nurse staffing with quality outcomes remains a topic of high interest. Failure to Rescue (FTR) is a National Quality Forum (NQF) nursing-sensitive performance measure and proposed 2010 CMS quality measure. FTR uses inpatient billing data to identify hospital acquired complications that end in death. Six FTR complication types are defined; for each, a denominator is constructed by applying inclusion and exclusion rules to ICD-9-CM discharge diagnoses and the numerator is number of deaths. Among the challenges in analyzing nurse staffing and FTR rates is the way nurse staffing is measured. Moreover, the impact of nursing shortages is at the shift and unit level, however the majority of studies are based on hospital level data and are cross-sectional thus one cannot associate staffing with unique patient outcomes. Objective: This study links nurse staffing to specific patients, examines two measures of nurse staffing obtained at the unit and shift level, and their association with failure to rescue. Methods: We examined over 250,000 Mayo Clinic hospital discharges from 2003-2006. The failure to rescue measure was constructed using the methods published by the Agency for Healthcare Research and Quality. Staffing measures were based a method for acuity adjusting unit census to recommend staffing needs on a shift-to-shift basis. Staffing measures included actual hours and the gap between recommended and actual hours. Logistic regression was used to analyze the impact of nurse staffing on FTR. Results: Of 22,683 discharges that met criteria for the denominator, 20,108 had a discharge status of alive. Age, presence of any of the six complications and the interaction of complications with a gap in staffing were most predictive of FTR (p&lt;.01). However different staffing measures exhibited different levels of significance within and across complication types. Conclusions: We have reported on a fully powered study of the effect of unit/shift level staffing on FTR. The specific measure of staffing affected the significance of the staffing variable in predicting FTR. Moreover, the impact of nurse staffing on FTR differed across the six FTR complication types. These findings have implications for studies of nursing sensitive outcomes.</td></tr></table>en_GB
dc.date.available2011-10-26T22:20:33Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T22:20:33Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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