Alternative Models of Nurse Staffing May Be Dangerous in High-Stakes Hospital Care.

Autor:	Lasater KB; Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA., Muir KJ; Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.; National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA., Sloane DM; Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA., McHugh MD; Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA., Aiken LH; Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Jazyk:	angličtina
Zdroj:	Medical care [Med Care] 2024 Jul 01; Vol. 62 (7), pp. 434-440. Date of Electronic Publication: 2024 Jun 07.
DOI:	10.1097/MLR.0000000000001990
Abstrakt:	Background: Hospitals are resurrecting the outdated "team nursing" model of staffing that substitutes lower-wage staff for registered nurses (RNs). Objectives: To evaluate whether reducing the proportion of RNs to total nursing staff in hospitals is in the best interest of patients, hospitals, and payers. Research Design: Cross-sectional, retrospective. Subjects: In all, 6,559,704 Medicare patients in 2676 general acute-care US hospitals in 2019. Measures: Patient outcomes: in-hospital and 30-day mortality, 30-day readmission, length of stay, and patient satisfaction. Avoidable Medicare costs associated with readmissions and cost savings to hospitals associated with shorter stays are projected. Results: A 10 percentage-point reduction in RNs was associated with 7% higher odds of in-hospital death, 1% higher odds of readmission, 2% increase in expected days, and lower patient satisfaction. We estimate a 10 percentage-point reduction in RNs would result in 10,947 avoidable deaths annually and 5207 avoidable readmissions, which translates into roughly $68.5 million in additional Medicare costs. Hospitals would forgo nearly $3 billion in cost savings annually because of patients requiring longer stays. Conclusions: Reducing the proportion of RNs in hospitals, even when total nursing personnel hours are kept the same, is likely to result in significant avoidable patient deaths, readmissions, longer lengths of stay, and decreased patient satisfaction, in addition to excess Medicare costs and forgone cost savings to hospitals. Estimates represent only a 10 percentage-point dilution in skill mix; however, the team nursing model includes much larger reductions of 40-50 percentage-points-the human and economic consequences of which could be substantial. Competing Interests: The authors declare no conflict of interest. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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