Washington Post Tackles Nurse Staffing Minimums, Quotes INQRI Experts

A recent Washington Post article analyzing the impact of nurse staffing minimums provides insight from two INQRI advisors.

 “There’s plenty of evidence that there’s a shortage of nursing care, and it’s not solved by anything to do with the hospital supply,”  Linda Aiken, INQRI research manager and National Advisory Committee member, tells the Washington Post. “All the shortage of care at the bedside has to do with how much hospitals want to pay nurses, and whether they want to use their resources on something else.”

Aiken’s recent research, published in the Lancet in February 2014, found that patients are more likely to die after common surgical procedures when they are cared for in hospitals with heavier nurse workloads and fewer nurses with bachelor's degrees. The study found that every extra patient increased the chance of surgical patients dying within 30 days of admission by 7 percent.

A California law requiring mandatory minimum nurse staffing has shown benefit for nurses, with studies showing that patient loads and rates of occupational injury decreased in the state, while job satisfaction among nurses increased. The Post reports, however, that there is conflicting evidence as to whether legislating mandatory minimum staffing improves patient outcomes. Lori Melichar, a labor economist for RWJF and program officer for INQRI, tells the Post that the question is complicated. “And when you layer on ‘Is this policy going to be effective,’ as a researcher and an economist, I can’t make that determination,” she says.

An INQRI-funded study on the impact of nursing staffing on hospital performance revealed that increasing the number of registered nurse (RN) hours per patient day increased the quality of patient care. The study looked in particular at patients who were being treated for acute myocardial infarction, pneumonia or heart failure.) For all three conditions, increasing the number of RN hours increased the quality of care. This did not hold true for increasing the number of licensed practical nurse or nursing assistant hours.

The study's authors—Gestur Davidson, Ira Moscovice, and Kathy Belk—posited that RNs are involved in and directly affect procedures, practices and processes that directly influence patient outcomes. This was the first study into how nurse staffing affects hospital performance on quality metrics used in the Premier Hospital Quality Demonstration project. It is reviewed in a 2013 research brief on the RWJF website.

Increasing Both Nurse and Doctor Staffing Levels Can Reduce Patient Mortality in ICUs – but Nurses Are Key

A new study in the International Journal of Nursing Studies finds that higher staffing levels for doctors and nurses in intensive care units (ICUs) are associated with higher survival rates for patients at high risk for death. The report, titled “Nurse staffing, medical staffing and mortality in Intensive Care: an observational study,” examines whether the number of nurses, doctors, and support staff affected the survival chances of critically ill patients in both the ICU and the hospital, HealthCanal reports.

Researchers reviewed information on nearly 40,000 patients from 65 ICUs in the United Kingdom. Among the findings, higher numbers of nurses per bed were associated with higher survival rates, and the number of nurses had the greatest impact on patients at a high risk of death when compared to other medical staffing levels.

An INQRI-funded study on the impact of nursing staffing on hospital performance revealed that increasing the number of registered nurse (RN) hours per patient day increased the quality of patient care. The study looked in particular at patients who were being treated for acute myocardial infarction, pneumonia or heart failure.) For all three conditions, increasing the number of RN hours increased the quality of care. This did not hold true for increasing the number of licensed practical nurse or nursing assistant hours.

The study's authors—Gestur Davidson, Ira Moscovice, and Kathy Belk—posited that RNs are involved in and directly affect procedures, practices and processes that directly influence patient outcomes. This was the first study into how nurse staffing affects hospital performance on quality metrics used in the Premier Hospital Quality Demonstration project. It is reviewed in a research brief on the Robert Wood Johnson Foundation website.

Increased RN Staffing Hours Are Correlated with Higher Quality Patient Care

An INQRI-funded study on the impact of nursing staffing on hospital performance revealed that increasing the number of registered nurse (RN) hours per patient day increased the quality of patient care. The study looked in particular at patients who were being treated for acute myocardial infarction, pneumonia or heart failure.)  For all three conditions, increasing the number of RN hours increased the quality of care. This did not hold true for increasing the number of licensed practical nurse (LPN) or nursing assistant (NA) hours.

The study's authors -- Gestur Davidson, Ira Moscovice and Kathy Belk -- posited that RNs are involved in and directly affect procedures, practices and processes that directly influence patient outcomes. This was the first study into how nurse staffing affects hospital performance on quality metrics used in the Premier Hospital Quality Demonstration project. It is reviewed in a new research brief on the Robert Wood Johnson Foundation website.

A Longitudinal Pridit Approach to Explaining Hospital Quality

Health outcomes can vary between high- and low-quality institutions, and research has been conducted to identify variables that determine hospital quality. However, new analysis by Robert D. Lieberthal and Dominique M. Comer builds on the prior investigation of hospital quality by evaluating a method originally developed for the detection of healthcare fraud, Pridit.

Pridit allows the ranking of hospitals, with respect to quality of care, using process measures and demographic attributes of the hospitals. Researchers developed a theoretical model to justify the application of Pridit to the hospital quality setting and then applied the method to a national, multiyear data set on U.S. hospital quality variables and outcomes. The results demonstrate how Pridit can be used to predict future health outcomes based on currently available quality measures. The empirical results obtained in this study may be of use to health insurers and policymakers who aim to improve quality in the hospital setting. The research content is available through the Wiley online library.

An INQRI study, Nursing Workforce Impact on Performance Improvement in the CMS/Premier Hospital Quality Incentive Demonstration Project (HQID), examined the impact of nurse staffing and nurses' work environment on hospital performance improvement in the HQID project. HQID is the first CMS demonstration on the impact of hospital pay-for-performance. Ira Moscovice and Mary Wakefield led the research team.