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Nurse Staffing and Quality of Care: What Does Current Research Tell Us? . Michigan Health and Safety Coalition April 14, 2004 Peter I. Buerhaus, PhD, RN, FAAN. Agenda. Overview of research on nurse staffing and quality of care Is there a business case for nursing?
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Michigan Health and Safety Coalition
April 14, 2004
Peter I. Buerhaus, PhD, RN, FAAN
Sample: 799 hospitals in 11 states, > 5 million
Length of stay, pneumonia, UGI bleeding,
shock/cardiac arrest, failure to rescue
Urinary tract infection, failure to rescue,
3-12% reduction in risk of adverse outcome
Sample: 256 California Hospitals
Conclusion: No to both questions
Question: Can Medicare only data (MedPAR) substitute for all-patient data?
Sample: > 12 million Medicare discharges
See: J. Needleman, J., Buerhaus, P. Stewart, M., Zelevinsky, K. “Measuring Hospital Quality: Can Medicare Data Substitute for All-Payer Data?” Health Services Research 2003 38(6):1487-1508.
Purpose: Determine whether quality of hospital care related to nursing has improved or worsened over time
Data: Approximately 50 million discharge abstracts
Funded by Agency for HealthCare Research and Quality
More RN time associated with …
Funded by The Commonwealth Fund
Pressure ulcer prevalence
Falls with injury
Restraint prevalence (vest and limb only)
Urinary tract infection
UTI – catheter associated
Central line associated blood stream infection
Ventilator associated pneumonia
Smoking cessation for AMI
Smoking cessation counseling for heart failure
Smoking cessation for pneumonia
Skill mix (RN, LPN, UAP and contract)
Nursing care hours per patient day (RN, LPN, UAP)
Practice environment (Nursing Work Index)
Nurses’ education preparation19 NQF Voluntary Nursing Performance Measures
Source: Buerhaus, Staiger, Auerbach. Implications of a rapidly aging RN workforce. JAMA 2000; 283 (22): 2948-2954.
B/S/A: Buerhaus, Staiger, Auerbach, 2002, updated forecasts originally published in JAMA, June 2000
Inpatient RN vs. Other RN’s