Too fewer permanent nurses in the wards are linked to longer stays, readmissions, patient deaths and ultimately more living and money, so long-term studies have been published online in the quality and safety of the journal BMJ.
Rectifying your balance is cost-effective and saves an estimated £4,728 for each year of healthy life acquired per patient, but not when temporary agency staff is being used to plug in gaps.
Researchers say that nurses in the wards are at risk of injuring hospital patients and are important contributors to nurse recruitment and retention issues, and careless staffing shortages in wards nurses – careful cost-saving measures – are inadequate.
Many of the existing studies on the impact of nursing staff: patient ratios are cross-sections and limited use in determining causal factors, they added.
To investigate whether investment in higher nurse staffing levels offsets staffing shortages, they set out to estimate the association between registered nurses and medical assistant staffing levels and patient death and risk of readmission.
They drew data provided by trusts of four NHS hospitals that provide diverse nurse staffing levels, size, educational status, and services to the diverse local population of the UK. The three trusts provided acute inpatient services primarily from a single hospital site, while the fourth provided inpatient services at four sites within one city.
Data originated from electronic healthcare records and staffing staffing, spanning the period from April 2015 to March 2020 for a total of 626,313 patients in 185 acute care wards.
This study included two major nursing team roles. Registered Nurse (RNS) who have completed university degree-level training and are registered with professional regulators. Nursing support staff who have not received this level of training and are rarely regulated (such as health care assistants).
The progressive cost-effectiveness of eliminating staffing shortages for these two roles was estimated from the costs and results of transitioning from averaged staffing shortages to planned staffing levels during the study period.
Patients spent an average of eight days in the ward. During the first five days of inpatient stay, patients were provided with a daily average of over 5 hours of care from the RNS and only 3 hours of care from nursing support staff.
The calculations showed that patients in understaffed wards are likely to die due to RN (5% vs 4% for patients with appropriate RN staffing levels), readmissions (15% vs 14%), and long stays in hospitals with similar numbers for the number of nurse support staff shortages (8 days vs 5 days).
Patients who experienced shortage received an average care shortage of 1 hour, 9 minutes per hour over the first 5 days, while patients who did not experience shortage received an average of 3 hours of 22 minutes of care above the ward average.
During the study period, 31,885 patients died. Every day, patients experienced a shortage of RN staffing (below ward average). The risk of death and readmission within 30 days of the first five days of stay increased by 8% and 1%, respectively. Five days after hospitalization, in the event of a shortage of staff, the length of stay increased by 69%.
Daily staff shortages in nursing support were associated with similar increases in duration of stay, with risk of death within 30 days, respectively. It is 7% and 61% respectively. However, the risk of readmission within 30 days was reduced by 0.6%.
The estimated total cost of providing care to 626,313 adults included in this study was £2,613,385,125, or £4,173 per hospitalization.
The researchers calculated that eliminating both nursing roles would result in an additional charge of £197 per patient attendance, avoiding £6,527 out of 31,885 deaths during the study period and avoiding gaining 44,483 health conditions.
This amounts to an extra £2,778 per year in a healthy year, and £2,685 if sick leave and recovery recovery decreases. However, considering the shorter length of stay, that means savings of £4,728 per year for a healthy living. This is an overall cost savings from an increase in staffing levels.
If agency staff were used instead to eliminate staffing shortages, staff costs for each year of additional healthy years acquired ranged from £7,320 to £14,639.
“The findings do not provide any indication that it makes rational economic sense to target efforts to correct low staffing in only the most acute patients. This is not only logistically difficult for patients with visual acuity (occurring in general wards), but also provides a rather high benefit in the cost per unit of improvement in the outcome,” the researchers explain.
“The steps to address the general (low visual acuity) low-population staffing could benefit hypertropic patients as long as they are in the same unit, but if the intervention is targeted at patients in hypertropic units, it is unlikely that there will be any opposition,” they add.
This is an observational study, and therefore it is not possible to draw solid conclusions about causes and effects. Additionally, researchers acknowledge that the data only originated from hospitals with the English language NHS, so it may not be applied any more widely. Staffing was judged in relation to ward norms rather than a validated assessment of staffing needs.
However, the researchers concluded: “When considering alternative policy strategies, this study demonstrates the importance of prioritizing investment in RNS adopted in wards over support staff.
