Quality of Care

Higher RN staffing is associated with fewer deaths among elderly Medicare patients hospitalized for heart attack

Over the past decade, many U.S. hospitals reduced the number of registered nurses (RNs) and substituted licensed practical nurses (LPNs) for RNs to reduce costs. In response to these cost-containment measures, there has been a call for government regulation of minimum staffing levels to protect the quality of care received by hospitalized patients.

A new study supported by the Agency for Healthcare Research and Quality (HS08843 and HS09446) found that higher RN staffing levels were associated with fewer deaths among elderly Medicare patients hospitalized for first-time heart attack. The researchers suggest that more astute RN clinical assessments and early identification of heart attack complications by RNs, such as congestive heart failure or pulmonary edema, may explain the survival advantage of patients treated at hospitals with higher RN staffing.

For the study, researchers from the University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center reviewed the medical records of 118,940 elderly, fee-for-service Medicare patients hospitalized for heart attack during 1994-1995 from nearly all U.S. acute care hospitals included in the Cooperative Cardiovascular Project. They linked these data with American Hospital Association data on participating hospitals and used Medicare data to determine patient deaths.

The survival advantage for the highest RN staffing levels was not large (on the order of 2 percent), but it persisted after adjusting for patient and hospital characteristics. From highest to lowest quartile of RN staffing, in-hospital mortality was 17.8 percent, 17.4 percent, 18.5 percent, and 20.1 percent, respectively. Conversely, from the highest to lowest quartile of LPN staffing, mortality was 20.1 percent, 18.7 percent, 17.9 percent, and 17.2 percent, respectively. These findings suggest an important effect of nurse staffing on in-hospital mortality. The researchers call for further investigation of how nurse staffing affects patient outcomes.

More details are in "Nurse staffing and mortality for Medicare patients with acute myocardial infarction," by Sharina D. Person, Ph.D., Jeroan J. Allison, M.D., M.S., Catarina I. Kiefe, Ph.D., M.D., and others, in the January 2003 Medical Care 42(1), pp. 4-12.

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