Effects of registered nurse staffing level on hospital-acquired conditions in cardiac surgery patients: A propensity score matching analysis.
BACKGROUND
The ramifications of inadequate nurse staffing may have serious consequences due to reimbursement policies.


OBJECTIVE
To determine the effects of registered nurse staffing on hospital-acquired conditions in cardiac surgery patients.


METHODS
Data from the 2009 to 2011 Nationwide Inpatient Sample were used to construct a propensity score-matched cohort. Multivariate regressions were performed to compare the probability, length of stay, mortality, and costs of three common hospital-acquired conditions between low- and high-staffing hospitals.


RESULTS
A total of 439,365 patients in low-staffing hospitals were 1:1 matched to patients in high-staffing hospitals. High-staffing hospitals had 10% to 25% fewer cases (adjusted odds ratio [AOR] 0.75-0.90, p < .0001), 5% to 20% lower mortality (AOR 0.80-0.95, p < .0001), and 4% to 6% shorter length of stay (coefficient -0.06 to -0.04, p < .0001). The costs for patients with hospital-acquired conditions were 13% to 17% greater in high-staffing hospitals (coefficient 0.13-0.17, p < .0001).


CONCLUSIONS
Alternatives to the current staffing and reimbursement policies should be considered to reduce hospital-acquired conditions.
Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR. Electronic address: xli@uams.edu.
Xiaocong
X
Li
Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR.
Stephen M
SM
Bowman
Department of Community Health, School of Health and Human Services, National University, San Diego, CA.
Tyler C
TC
Smith
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration* / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology*; D057216:Propensity Score; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000451:nursing* / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
Cardiac surgery; Hospital-acquired conditions; Nurse staffing; Propensity score matching