title: The costs and savings associated with prevention of adverse events by critical care nurses.
abstract: OBJECTIVE
  The aim of the study was to determine the costs and savings associated with prevention of adverse events (AEs) by critical care nurses.
  
  
  METHODS
  We performed a secondary analysis of data from 2 coronary care unit (CCU) studies that determined the incremental cost of AEs and the rate of near misses recovered by nurses during weekday, daytime shifts. For this study, we determined the nurse staffing costs and savings by averting AEs. Physicians judged the likelihood that observed near misses would have resulted in actual AEs if not initially intercepted. A sensitivity analysis was performed on the savings from preventing AEs and the costs of different nurse staffing ratios and experience levels.
  
  
  RESULTS
  We observed 66 recovered near misses during 308 observation hours, with 34 (51.5%) judged to likely have reached and harmed the patient resulting in an AE if not intercepted. The annual incidence of prevented AEs extrapolated to 2296 events. Savings from prevented AEs ranged from $2.2 million to $13.2 million. Nurse staffing costs for the same time frame was $1.36 million.
  
  
  CONCLUSIONS
  Although CCU nursing staffing costs are significant, the potential savings associated with preventing AEs is far greater. Further research is needed to identify the optimal nurse staffing ratios.
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120-1613, USA. jrothschild@partners.org
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rothschild
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: Calvin
authors.initials: C
authors.lastname: Franz
authors.forename: Jane R
authors.initials: JR
authors.lastname: Soukup
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal