January 10, 2006

Study Aims to Make Business Case for More RNs

By Kim Dixon

CHICAGO -- Hospitals could reduce patient deaths and expensive complications by boosting the proportion of registered nurses on their staff without an increase in costs, according to a proposal aimed at making a "business case" for better nursing care released on Tuesday.

The study in the journal Health Affairs posited several approaches to improve the quality of care in hospitals, under a spotlight since a series of government reports in the late 1990s underscored the role of human error in tens of thousands of unnecessary deaths.

It finds that hospitals could avoid 5,000 annual patient deaths if they boosted the proportion of registered nurses, by replacing 37,000 licensed practical nurses with RNs. LPNs require less training and education compared with RNs.

Based on data from 800 acute-care hospitals, researchers found that boosting the mix of RNs and LPNs, while keeping the number of total nursing hours constant, would cost hospitals $811 million, but save $1 billion in the short term.

"It certainly pays for itself to simply increase the number of RNs without increasing the number of hours of care," said Jack Needleman, an associate professor in the school of public health at the University of California at Los Angeles and lead author.

Over the longer term, the savings are estimated at $2.6 billion.

A large body of medical literature positively links nursing staffing to lower rates of hospital-linked complications like heart attacks and urinary tract infections, and also with shorter lengths of stay and fewer patient deaths.

The new analysis attempts the quantify the cost and savings to hospitals, beyond the obvious social benefits of preventing unnecessary deaths, Needleman said.

"There is a compelling need to understand better the economic implications for all stakeholders of implementing quality improvement," the paper said.

The authors projected data from the 800 sample hospitals to all hospitals and included estimates on needed staffing, avoided adverse outcomes, admissions, and lengths of stay for 2002.

The study authors suggested several alternative scenarios to improve patient care and quality, including increasing the numbers of both LPNs and RNs, a proposal that cost would $1.7 billion in the short term.

That leads to a broader public policy question, because increased funds would need to come from somewhere, perhaps Congress, Needleman said.