RT Journal Article
SR Electronic
T1 Valuing hospital investments in nursing: multistate matched-cohort study of surgical patients
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 46
OP 55
DO 10.1136/bmjqs-2019-010534
VO 30
IS 1
A1 Karen B Lasater
A1 Matthew McHugh
A1 Paul R Rosenbaum
A1 Linda H Aiken
A1 Herbert Smith
A1 Joseph G Reiter
A1 Bijan A Niknam
A1 Alexander S Hill
A1 Lauren L Hochman
A1 Siddharth Jain
A1 Jeffrey H Silber
YR 2021
UL http://qualitysafety.bmj.com/content/30/1/46.abstract
AB Background There are known clinical benefits associated with investments in nursing. Less is known about their value.Aims To compare surgical patient outcomes and costs in hospitals with better versus worse nursing resources and to determine if value differs across these hospitals for patients with different mortality risks.Methods Retrospective matched-cohort design of patient outcomes at hospitals with better versus worse nursing resources, defined by patient-to-nurse ratios, skill mix, proportions of bachelors-degree nurses and nurse work environments. The sample included 62 715 pairs of surgical patients in 76 better nursing resourced hospitals and 230 worse nursing resourced hospitals from 2013 to 2015. Patients were exactly matched on principal procedures and their hospital’s size category, teaching and technology status, and were closely matched on comorbidities and other risk factors.Results Patients in hospitals with better nursing resources had lower 30-day mortality: 2.7% vs 3.1% (p<0.001), lower failure-to-rescue: 5.4% vs 6.2% (p<0.001), lower readmissions: 12.6% vs 13.5% (p<0.001), shorter lengths of stay: 4.70 days vs 4.76 days (p<0.001), more intensive care unit admissions: 17.2% vs 15.4% (p<0.001) and marginally higher nurse-adjusted costs (which account for the costs of better nursing resources): $20 096 vs $19 358 (p<0.001), as compared with patients in worse nursing resourced hospitals. The nurse-adjusted cost associated with a 1% improvement in mortality at better nursing hospitals was $2035. Patients with the highest mortality risk realised the greatest value from nursing resources.Conclusion Hospitals with better nursing resources provided better clinical outcomes for surgical patients at a small additional cost. Generally, the sicker the patient, the greater the value at better nursing resourced hospitals.