Abstract
BackgroundMany hospitals have reformed hospital policies and changed nursing models to cope with shortages in nursing staff and control medical costs. However, the nursing skill mix model that most successfully achieves both cost effectiveness and quality care has yet to be determined.AimThe aim of this study was to explore the impact of different nurse staffing models on patient outcomes in a respiratory care center (RCC).MethodsRetrospective data from 2006 to 2008 were obtained from records monitoring nursing care quality, as well as patient records and nursing personnel costs in an RCC as a medical center, in southern Taiwan. A total of 487 patients were categorized into two groups according to the RCC's mix of nursing staff. The “RN/Aide” group comprised 247 patients who received RN and aide care, with a 0.7–0.8 proportion of RNs, from July 2006 to June 2007. The other 240 patients (“All-RN”) received 100% RN care from January 2008 to December 2008.ResultsThe results of this study indicated no significant differences in occurrence of pressure ulcer or respiratory tract infections, days of hospitalization, mortality, or nursing costs. However, significant differences were observed in ventilator weaning and occurrence of urinary tract and bloodstream infections.ConclusionsA higher proportion of RNs was associated not only with a lower rate of urinary tract infection but also with more patients being weaned successfully from ventilators. The findings of this study have implications for how managers and administrators manage nurse staffing in respiratory care.
Highlights
Many hospitals have reformed hospital policies and changed nursing models to cope with shortages in nursing staff and control medical costs
Seeking further understanding of the impact of nurse staffing on patient outcomes, our research examined the following: (1) differences in patient outcomes between patients who received “All-registered nurses (RN) care” and patients who received “RN/Aide care”; and (2) differences in staffing costs between the two aforementioned groups
Comparisons of Patient Outcomes and Nursing Costs In terms of patient outcomes, no significant difference existed in the occurrence of pressure ulcers and respiratory infections, the mean lengths of respiratory care center (RCC) stay, mortality, or nursing costs
Summary
Many hospitals have reformed hospital policies and changed nursing models to cope with shortages in nursing staff and control medical costs. Results: The results of this study indicated no significant differences in occurrence of pressure ulcer or respiratory tract infections, days of hospitalization, mortality, or nursing costs. Conclusions: A higher proportion of RNs was associated with a lower rate of urinary tract infection and with more patients being weaned successfully from ventilators. Orrett (2002) analyzed data obtained from 629 ICU inpatients and discovered that the respiratory tract (29.5%), surgical wounds (25.2%), and urinary tract (20.1%) were the most common sites of nosocomial infection Nosocomial pneumonia among such patients was common and associated with the use of ventilators (87.4%), resulting in higher mortality rates and more days of hospitalization than nonventilator-associated pneumonia (Suka et al 2007). Patients without infections had a higher ventilator-weaning rate and lower mortality rate than patients with infections. Aboussouan et al (2008) assessed the factors affecting mortality among 117 patients in a respiratory unit and found that patients older than age 65 who developed pressure ulcers and failed to be weaned from the ventilator had a higher rate of mortality
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