Date and Time
November 7, 2007
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Speaker
Ciaran S. Phibbs - CHP/PCOR Associate at VA Palo Alto Health Care System's Health Economics Resource Center

Objectives:

There is an emerging evidence base on the effect of nurse staffing levels on patient outcomes in acute care hospitals and increased interest in mandating nurse staffing ratios. This project is extending this work by using monthly, unit-level data for a large panel of hospitals to obtain more precise estimates of the effect of nurse staffing. It also extends previous work by considering how human capital factors such as nursing education, experience, and turnover modify the effects of nursing staffing levels.

Methods:

Data for all VA acute inpatient care for FY 03-06. Nursing sensitive patient outcomes were derived using the Agency for Healthcare Research and Quality (AHRQ) and Patient Safety Indicators (PSI) software. Nurse staffing for each unit was obtained from the VA Decision Support System. The human capital variables were extracted from VA payroll data (PAID). All variables were aggregated by month for each inpatient unit, at each VA facility.

Results:

Initial results have been run for 401 acute and 173 ICU units. Although the parameters estimates show an association of reduced PSI rates with higher nurse staffing, many of the estimates were not statistically significant and their magnitudes were smaller than what has been reported in the literature. Refinements to the models are in process.

Conclusions:

While VA nurse staffing appears to affect patient outcomes, the effects are smaller than what has been previously reported for non-VA hospitals. We are currently investigating if these differences in results are due to our use of more detailed data.

Impact Statements:

This study extends the literature on the relationship between nurse staffing and patient outcomes by using monthly data from each inpatient unit of the hospital, and by considering human capital factors that have not been considered in most previous study. In contract, most previous studies have used annual data for all inpatients, with no controls for human capital factors. Given the size of our sample and the detailed information that we have available about nurse staffing, this study will be the most definitive study to date of the effects of nurse staffing on patient outcomes.