Safety and Savings: The Value of More Staff Time with Patients

The Value of More Staff Time with Patients

January 31, 2012 - We’ve all heard the expression that “Time is money.” This rings true in industry and in healthcare in regards to the importance of overall efficiency. But a clinician’s time with patients can mean more than that--it can literally mean the difference between life and death, or between a good outcome and a bad one.

The more time that clinicians spend in direct patient care, the more likely they are to catch changes in a patient’s condition or to discover a symptom that may have a bearing on that individual’s treatment and recovery. In fact, a number of recent studies have shown that maximizing the time that nurses have to care for their patients by adjusting staffing numbers is a key factor in improving outcomes and avoiding “never events,” and the unfortunate and costly consequences that accompany them.

I recently reviewed several major studies in this area with two colleagues, Bette Case Di Leonardi, Ph.D., RN –BC, an independent healthcare consultant, and Karen Siroky, MSN, RN –BC, AMN’s clinical director, education and training. We explored the relationship between nurse staffing and preventable medical errors and published the results in a white paper entitled Preventing Never Events: Evidence-based Nurse Staffing, which can be downloaded from the AMN Healthcare site.

As we reviewed and analyzed the findings, we were reminded of the fact that reducing preventable adverse events is an extremely complex issue. But there are also a few points that were made clear:

1. You can make a business case for staffing changes that improve safety. By combining the latest research results linking staffing adequacy with improved patient outcomes and the financial implications for your particular institution, you can help quantify safety goals and enact positive changes. From reducing HAIs and pressure ulcers to incidents of cardiac arrests and even mortality rates, the savings can be substantial.

2. Multiple definitions and measurements for adverse events exist. There are various lists of “adverse events” and “never events” in circulation, including the 2007 list of Serious Reportable Events from the National Quality Forum (NQF) and the Healthcare Acquired Infections (HAIs) list from the Centers for Medicare and Medicaid Services (CMS), which they use to approve or deny reimbursements. We looked at these and provided a comparison for readers.

3. Improvement efforts are plentiful. There are a number of quality initiatives with similar goals of reducing adverse events among top healthcare organizations, ranging from The Joint Commission, the American Hospital Association, the Leapfrog Group and a variety of professional associations. Although there are mandatory elements, hospitals also have some leeway to determine for themselves which initiatives they can and should embrace.

4. Errors still happen, with enormous human and financial consequences. Despite the many initiatives addressing never events, the errors continue--and they are costly. A 2010 study, for instance, found that 1.5 million injuries occur in hospital settings each year, at an average cost of $13,000 per injury, or more than $19.5 billion in the United States alone.

Another 2010 study by the Department of Health and Human Services estimated that 134,000 Medicare patients experienced at least one adverse event in hospitals during a one-month period; it also tracked 15,000 patient deaths due to medical errors in just one month, at which rate we would see 180,000 patient deaths in one year due to medical errors.

5. Nurses can make a difference in reducing errors. We looked at more than 40 studies from top researchers and government agencies and found ample evidence that putting more qualified nurses on the floor can significantly reduce the rate of medical errors. One example from a Pennsylvania study showed surgical deaths could have been reduced by 11 percent if hospitals there had employed one registered nurse (RN) for every 2.5 patients. Not all facilities would find this much improvement, but the data showed the average was still substantial.

Whether you measure by nurse-to-patient ratios or RN hours per patient day, increasing the balance of qualified nurses in staffing plans clearly relates to a decrease in never events and other errors.

6. Spending more (but wisely) can help you save. Using the research data, we were able to extrapolate the potential financial impact for facilities that might choose to increase their permanent and supplemental nurse staffing. One calculation showed the financial investment required to bring RN staffing up to research-recommended levels in order to reap the financial rewards in less staff turnover and reduced patient deaths; the second showed how improving RN hours per patient day will reduce costly adverse events.

Just increasing the number of nurses on your payroll is not the whole answer, of course, but a strategic staffing plan can help you become more efficient and find the right balance of people at the right time--resulting in more time with patients, better care and lower costs.

For more information, download a complimentary copy of Preventing Never Events: Evidence-based Nurse Staffing.