The costs and savings associated with prevention of adverse events by critical care nurses

doi:10.1016/j.jcrc.2007.12.021

Journal of Critical Care

Volume 24, Issue 3, September 2009, Pages 471.e1-471.e7

https://doi.org/10.1016/j.jcrc.2007.12.021 Get rights and content

Abstract

Purpose

The aim of the study was to determine the costs and savings associated with prevention of adverse events (AEs) by critical care nurses.

Materials and Methods

We performed a secondary analysis of data from 2 coronary care unit (CCU) studies that determined the incremental cost of AEs and the rate of near misses recovered by nurses during weekday, daytime shifts. For this study, we determined the nurse staffing costs and savings by averting AEs. Physicians judged the likelihood that observed near misses would have resulted in actual AEs if not initially intercepted. A sensitivity analysis was performed on the savings from preventing AEs and the costs of different nurse staffing ratios and experience levels.

Results

We observed 66 recovered near misses during 308 observation hours, with 34 (51.5%) judged to likely have reached and harmed the patient resulting in an AE if not intercepted. The annual incidence of prevented AEs extrapolated to 2296 events. Savings from prevented AEs ranged from $2.2 million to $13.2 million. Nurse staffing costs for the same time frame was $1.36 million.

Conclusions

Although CCU nursing staffing costs are significant, the potential savings associated with preventing AEs is far greater. Further research is needed to identify the optimal nurse staffing ratios.

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.

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The costs and savings associated with prevention of adverse events by critical care nurses☆

Abstract

Purpose

Materials and Methods

Results

Conclusions

Section snippets

Study site

Results

Discussion

Acknowledgments

J Prof Nurs

Appl Nurs Res

Changes in critical care beds and occupancy in the United States 1985-2000: differences attributable to hospital size

Crit Care Med

Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs

Crit Care Med

The Critical Care Safety Study: the incidence and nature of adverse events and serious medical errors in intensive care

Crit Care Med

To err is human. Building a safer health system. Institute of Medicine

Acute decompensation after removing a central line: practical approaches to increasing safety in the intensive care unit

Ann Intern Med

Committee on the Work Environment for Nurses. Keeping patients safe: transforming the work environment of nurses

Nurse-staffing levels and the quality of care in hospitals

N Engl J Med

The costs of adverse events in intensive care units

Crit Care Med

Recovery from medical errors: the critical care nursing safety net

Jt Comm J Qual Patient Saf

Effect of eliminating extended work shifts and reducing work hours on serious medical errors among interns in intensive care units

N Eng J Med

A controlled trial of smart infusion pumps to improve medication safety in critically ill patients

Crit Care Med