Sources of nurse-sensitive inpatient safety improvement.

Abstract

To examine the association of hospital expenditure with continuing nurse education and staffing on improvements in nurse-sensitive, patient-safety outcomes. Data obtained from 12-year (2007-2018) panel of Florida acute-care general hospitals. We assess the relationship of hospital expenditure on continuing nurse education and staffing on nurse-sensitive, patient-safety outcomes from the Agency for Healthcare Research and Quality: advanced-stage (stage 3 or 4) pressure injuries/ulcers, central venous catheter-related blood stream infection, and deep vein thrombosis. We attempt to mitigate expected omitted-variable bias by (1) exploiting the panel structure of our data, controlling for time and time-invariant hospital fixed effects and (2) incorporating measurable variables representing four unobserved hospital characteristics underlying hospital safety culture (organizational type, organizational structure, leadership, and market conditions) that are likely associated with both inpatient safety and our key determinants. We include two policy initiatives that took effect during the period under study. From our initial sample of 177 acute-care hospitals we exclude hospitals with missing variables or years of data. Our samples are a balanced panel of 150 acute-care hospitals (N=1800) for pressure ulcer and catheter-related blood stream infection, and 143 hospitals (N=1716) for deep vein thrombosis. A one standard deviation increase in nursing education-policy interaction is associated with a 16.6% (p < 0.01) reduction in the rate of catheter-related blood stream infection and associated with an almost 5% (p < 0.05) reduction in the rate of deep vein thrombosis; a one standard deviation increase in staffing per 1000 inpatient days is associated with a 68.5% reduction in pressure-ulcer rates: 31.4% from direct staffing (p < 0.01) and 37.1% from policy-staffing interaction (p < 0.01). Our findings suggest that there are tradeoffs between funding continuing education and training of existing staff and expanding staff to achieve patient safety objectives.