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Purpose A growing body of research has shown a link between nurse staffing and patient outcomes. As a result, 14 states have introduced legislation to limit patient-to-nurse ratios, placing a considerable financial burden on hospitals. Although lower ratios could decrease length-of-stay and nursing turnover, offsetting some of the additional labor costs, mandatory ratios could also drive up nursing wages in an already tight market. Our objective was to determine the marginal cost-effectiveness of various nurse staffing ratios. Methods Adopting the societal perspective, we conducted a cost-effectiveness analysis for general medical and surgical patients comparing patient-to-nurse ratios ranging from 8:1 to 4:1. Cost estimates were drawn from national databases. The effects of nurse staffing on patient mortality and length of stay were based on two large hospital level studies. Outcomes were measured in cost per life saved. The potential contributions of nursing turnover and elasticity of labor supply were addressed in sensitivity analysis. Results In the base case analysis, 8 patients per nurse was the least expensive ratio, but was associated with the highest patient mortality. Decreasing the number of patients per nurse improved mortality and increased costs, becoming progressively less cost-effective as the ratio declined from 8:1 to 4:1. Nonetheless, the marginal cost-effectiveness did not exceed $85,000 (95% C.I. $42,000 to $260,000) per life saved. Lower ratios generated savings from shorter lengths of stay, but these offset less than half of the increase in labor costs. The model was most sensitive to variations in mortality rates associated with different patient-to-nurse ratios. Several other factors made low ratios more cost-effective: a) low hourly wages, b) high labor elasticity, c) short length of stay, and d) registered nurse-hours decreasing length of stay. However, throughout the ranges of all these variables, the marginal cost-effectiveness of limiting the ratio to 4:1 never exceeded $280,000 per life saved. Conclusions As a patient safety intervention, patient-to-nurse ratios of 4:1 are reasonably cost-effective and in the range of other commonly accepted interventions. More accurate estimates of the effect of nurse staffing on patient mortality are needed.
See more of Poster Session - CEA: Methods and Applications; Health Services Research
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)