There is a link between nurse staffing, in terms of hours and skill mix, and certain patient outcomes. These outcomes have been identified as being potentially sensitive to nursing care (OPSNs). The purpose of this Literature Review was to see whether there is evidence that the cost of these OPSNs could be quantified. The findings suggest that costing of OPSNs is possible, and is generally done through the use of a hospital accounting system. However, costing using this method would appear to be a time-consuming and not entirely accurate process, which has thus far been carried out for research purposes only, and with a relatively small sample of patients. Accounting systems appear to be improving, and are now widely used in Canada and the United States.
Purpose
The brief for this review was to find out whether there was any evidence that the cost of these nurse-sensitive adverse outcomes could be quantified.
Methodology
This review represents an attempt to identify the way in which costs associated with patients developing OPSNs have been calculated so far. A range of information sources were searched for information pertaining to the key terms ‘cost’, ‘outcomes potentially sensitive to nursing’, ‘nurse-sensitive outcomes’, ‘adverse events’ and ‘patient safety’.
Google and Google Scholar were used, alongside PubMed (Medline), PubMed Central and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). The following journals were also searched: Nursing Economics, Journal of Advanced Nursing, Policy, Politics, and Nursing Practice and the Journal of Nursing Administration. Relevant articles having been identified, any possibly relevant articles cited within them were also investigated, along with others arising from PubMed’s ‘related citations’ facility.
Key Results
The review identified very little relevant literature. This first section summarises the small set of articles that were found. Due to the limited nature of the available literature, the scope of the review was broadened to include a portion of the considerably larger body of literature on the costing of adverse events in general. Information presented in such articles is typically quite technical and not easy to summarise: consequently, this review quotes excerpts directly where relevant.
Some literature, although appearing (on the basis of title) to be relevant to this review, did not entail any specific method of calculating the cost of patient outcomes. For example, although Aiken’s 2008 article on the economics of nursing discusses the association between patient outcomes and specific qualities of the nursing workforce, such as registration, education, staffing hours and practice environment, it only goes so far as to describe adverse patient outcomes and patient care expenses as ‘costly’, and able to be offset by investment in nursing resources, providing no further monetary detail. Similarly, Davis, Lay-Yee, Bryant, et al’s 2002 study of adverse events in New Zealand hospitals concludes that:
- The findings suggest that adverse events are as significant a problem in New Zealand as they are in Australia, the UK, and the United States. In essence, about one in eight admissions to a hospital are associated with adverse events (which may have occurred within or outside public hospitals). The majority of such incidents have a relatively minor impact on patients (though there is a significant proportion who suffer permanent disability or death), but their effects on hospital workload, and thus costs to the health system, are substantial.