Greater nurse staffing may improve patient outcomes and reduce costs

1. There were lower 30-day mortality rates two years after implementation of the nursing ratio policy compared to baseline.

2. The reduction in length of stay and readmission rates reduced health care costs substantially.

Evidence Rating Level: 2 (Good)

Study Rundown: Public policy implementing minimum nurse-to-patient ratios have sought to improve patient outcomes with increased staffing standards. This prospective panel study evaluates efficacy and outcomes after Queensland implemented nursing ratios for adult medical-surgical wards at public hospitals in 2016. The results of this study demonstrated public policy intervention was effective at decreasing the average number of patients per nurse. In intervention hospitals, improvements in mortality, length of stay (LOS), and readmission rates were observed compared to pre-intervention. This entailed significant cost savings despite cost associated with increased staffing; thus, increased staffing was found to be advantageous for hospitals. This study contributes to the body of literature supporting increased staffing for better patient outcomes with more manageable nursing workload and positive returns on investment.

Click to read the study in The Lancet

Relevant Reading: Valuing hospital investments in nursing: multistate matched-cohort study of surgical patients

In-Depth [prospective cohort]: This study collected nurse-reported survey data at baseline and 2- years post-intervention from 55 hospitals, 27 of which affected by the minimum nursing ratio intervention (intervention hospitals) and 28 of which were comparison hospitals. Patient characteristics were collected as well. The primary outcome was nurse-to-patient ratio; other outcomes of interest were 30-day mortality, LOS, and 7-day readmission. At baseline, patients at intervention hospitals were generally sicker, as demonstrated through longer baseline LOS compared to comparison hospitals. After policy implementation, the average number of patients per nurse at comparison hospitals was 5.96 vs 4.37 at intervention hospitals. 30-day mortality was reduced post-intervention compared to baseline at intervention hospitals (OR = 0.89, 95% CI [0.84-0.95], p=0·0003), as were 7-day readmission rates (0·93, [0.89–0.97], p<0.0001). When the effects of staffing changes were assessed, intervention effect was significant for reduced LOS (incident rate ratio = 0.93, 95% CI [0·91–0·95], p<0.0001). The results of this study are limited by patient-level differences prior to intervention, non-randomized implementation of nursing ratios, and unmatched hospital characteristics. Despite these limitations, this study provided insight into the effects of public policy on patient outcomes through staffing minimums, justifying future research in this area.

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