AHRQ Study Links Hospital Nurse Staffing Increases to Fewer Adverse Events, Lower Lengths of Stay

Increases in hospital nurse staffing levels are associated with reductions in adverse events and lengths of stay and do not lead to increased costs, a longitudinal study by AHRQ concluded. Researchers also found that increasing the number of registered nurses, as opposed to other nursing positions, led to reduced costs. The authors linked hospital nurse staffing data to AHRQ’s Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from California, Maryland and Nevada between 2008 and 2011 to estimate the causal relationship between nurse staffing (level and skill mix), quality (adverse events as measured by nurse-sensitive patient safety indicators), lengths of stay and cost. The findings suggest that increased staffing of registered nurses can improve patient outcomes and efficiency. "Examining the Value of Inpatient Nurse Staffing: An Assessment of Quality and Patient Care Costs" and the abstract appeared in the November issue ofMedical Care. Authors included AHRQ’s H. Joanna Jiang, Ph.D., and Carol Stocks, Ph.D., R.N.

2014 Nov;52(11):982-8. doi: 10.1097/MLR.0000000000000248.

Examining the value of inpatient nurse staffing: an assessment of quality and patient care costs.

Martsolf GR1, Auerbach D, Benevent R, Stocks C, Jiang HJ, Pearson ML, Ehrlich ED, Gibson TB.

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Abstract

BACKGROUND:

Inpatient quality deficits have important implications for the health and well-being of patients. They also have important financial implications for payers and hospitals by leading to longer lengths of stay and higher intensity of treatment. Many of these costly quality deficits are particularly sensitive to nursing care.

OBJECTIVE:

To assess the effect of nurse staffing on quality of care and inpatient care costs.

DESIGN:

Longitudinal analysis using hospital nurse staffing data and the Healthcare Cost and Utilization Project State Inpatient Databases from 2008 through 2011.

SUBJECTS:

Hospital discharges from California, Nevada, and Maryland (n=18,474,860).

METHODS:

A longitudinal, hospital-fixed effect model was estimated to assess the effect of nurse staffing levels and skill mix on patient care costs, length of stay, and adverse events, adjusting for patient clinical and demographic characteristics.

RESULTS:

Increases in nurse staffing levels were associated with reductions in nursing-sensitive adverse events and length of stay, but did not lead to increases in patient care costs. Changing skill mix by increasing the number of registered nurses, as a proportion of licensed nursing staff, led to reductions in costs.

CONCLUSIONS:

The study findings provide support for the value of inpatient nurse staffing as it contributes to improvements in inpatient care; increases in staff number and skill mix can lead to improved quality and reduced length of stay at no additional cost.