Abstract
To identify the costs associated with nurse sensitive adverse events and the impact of these events on patients' length of stay. Retrospective cohort study using administrative hospital data. Data were sourced from patient discharge information (N=5544) from six acute wards within three hospitals (July 2016-October 2017). A retrospective patient record review was undertaken by extracting data from the hospitals' administrative systems on inpatient discharges, length of stay and diagnoses; eleven adverse events sensitive to nurse staffing were identified within the administrative system. A negative binomial regression is employed to assess the impact of nurse sensitive adverse events on length of stay. Sixteen per cent of the sample (n=897) had at least one nurse sensitive adverse event during their episode of care. The model revealed when age, gender, admission type and complexity are controlled for, each additional nurse sensitive adverse event experienced by a patient was associated with an increase in the length of stay beyond the national average by 0.48days (p=.001). Applying this to the daily average cost of inpatient stay per patient (€1456), we estimate the average cost associated with each nurse sensitive adverse event to be €694. Extrapolating this nationally, the economic cost of nurse sensitive adverse events to the health service in Ireland is estimated to be €91.3 million annually. These potentially avoidable events are associated with a significant economic burden to health systems. The estimates provided here can be used to inform and prepare the way for future economic evaluations of nurse staffing initiatives that aim to improve care and safety. As many of these nurse sensitive adverse events are avoidable, in addition to patient benefits, there is a potential substantial financial return on investment from strategies such as improved nurse staffing that can reduce their occurrence.
Highlights
IntroductionThere is an increased focus on ensuring patient safety and quality of care (Ehsani et al, 2006); this is driven, in part, by the substantial rate of adverse events in hospital settings (Rafter et al, 2017; Schwendimann et al, 2018; Thomas & Brennan, 2001; Vincent et al, 2001)
One approach to determining the economic costs of adverse events is through the measurement of nurse sensitive adverse events, which, following Needleman et al, (2002) seminal work, are defined as patient outcomes that are potentially sensitive to nursing care
We estimated the average cost associated with each nurse sensitive adverse event to be €694; this was lower than the costs identified in the United States, where the cost per adverse event per case increased by €1590 in medical patients and €1396 in surgical patients (2008 USD converted to 2019 EUR) (Pappas, 2008)
Summary
There is an increased focus on ensuring patient safety and quality of care (Ehsani et al, 2006); this is driven, in part, by the substantial rate of adverse events in hospital settings (Rafter et al, 2017; Schwendimann et al, 2018; Thomas & Brennan, 2001; Vincent et al, 2001) These adverse events can result in serious health outcomes for patients and financial consequences for health systems (Ehsani et al, 2006; Kjellberg et al, 2017). As health services internationally are operating in an environment where resources are scarce and efficiencies are widely sought (Mittmann et al, 2012), nurse staffing is frequently the area of the health workforce that is reduced when savings are required (Pappas, 2008; Williams et al, 2017), and as a consequence, nurse sensitive adverse events can increase, which have significant human and economic costs
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