The costs and savings associated with prevention of adverse events by critical care nurses☆
Section snippets
Study site
This study is an analysis of the coronary care unit (CCU) data from the Critical Care Safety Study [3], which was conducted as part of the Harvard Work Hours and Health Study [11], from July 2002 to June 2003 and the Critical Care Nursing Safety Net Study [10] from July 2003 to June 2004. Institutional human subject review boards approved these studies. Incident definitions, including adverse events and near misses, are provided in Table 1.
The studies were conducted in the 10-bed CCU of a
Results
The proportion of nonintercepted near misses that would have resulted in harm, prevented AEs, was 51.5% (34/66). The remaining incidents were rated as either unlikely to have caused a prevented AE (16/66 [24.2%]) or could not be determined as to the likelihood of harm (16/66 [24.2%]). The κ for interrater reliability was 0.62, considered good.
Discussion
We found that nurse staffing costs under different staff conditions were less than the expected cost savings from prevented AEs. The cost-effectiveness associated with prevention of AEs by nurses in critical care units with varying nursing experience or intensities is difficult to determine because the direct impact of different nursing staffing standards on the rate of prevented AEs is unknown. However, comparing the ranges of likely savings from prevented AEs and the costs of different
Acknowledgments
This study was supported by grants from the Robert Wood Johnson Foundation and California HealthCare Foundation. The study sponsors had no role in the study design, in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
We thank Drs. Danielle B. Scheurer and Allen B. Kachalia for their rating of near misses. We also thank the investigators of the Critical Care Safety Study, especially Drs.
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The authors have no financial and personal relationships with other people or organizations that could inappropriately influence our work.