Association between nursing cost and patient outcomes in intensive care units: A retrospective cohort study of Belgian hospitals

Arnaud Bruyneel; Lionel Larcin; Jérôme Tack; Julie Van Den Bulcke; Magali Pirson

doi:10.1016/j.iccn.2022.103296

Association between nursing cost and patient outcomes in intensive care units: A retrospective cohort study of Belgian hospitals

Intensive Crit Care Nurs. 2022 Dec:73:103296. doi: 10.1016/j.iccn.2022.103296. Epub 2022 Jul 22.

Authors

Arnaud Bruyneel¹, Lionel Larcin², Jérôme Tack³, Julie Van Den Bulcke⁴, Magali Pirson⁴

Affiliations

¹ Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium; CHU Tivoli, La Louvière, Belgium. Electronic address: https://twitter.com/@ArnaudBruyneel.
² Research Centre for Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Belgium.
³ Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium.
⁴ Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.

PMID: 35871959
DOI: 10.1016/j.iccn.2022.103296

Abstract

Introduction: Hospitals with better nursing resources report more favourable patient outcomes with almost no difference in cost as compared to those with worse nursing resources. The aim of this study was to assess the association between nursing cost per intensive care unit bed and patient outcomes (mortality, readmission, and length of stay).

Methodology: This was a retrospective cohort study using data collected from the intensive care units of 17 Belgian hospitals from January 01 to December 31, 2018. Hospitals were dichotomized using median annual nursing cost per bed. A total of 18,235 intensive care unit stays were included in the study with 5,664 stays in the low-cost nursing group and 12,571 in the high-cost nursing group.

Results: The rate of high length of stay outliers in the intensive care unit was significantly lower in the high-cost nursing group (9.2% vs 14.4%) compared to the low-cost nursing group. Intensive care unit readmission was not significantly different in the two groups. Mortality was lower in the high-cost nursing group for intensive care unit (9.9% vs 11.3%) and hospital (13.1% vs 14.6%) mortality. The nursing cost per intensive care bed was different in the two groups, with a median [IQR] cost of 159,387€ [140,307-166,690] for the low-cost nursing group and 214,032€ [198,094-230,058] for the high-cost group. In multivariate analysis, intensive care unit mortality (OR = 0.80, 95% CI: 0.69-0.92, p < 0.0001), in-hospital mortality (OR = 0.82, 95% CI: 0.72-0.93, p < 0.0001), and high length of stay outliers (OR = 0.48, 95% CI: 0.42-0.55, p < 0.0001) were lower in the high-cost nursing group. However, there was no significant effect on intensive care readmission between the two groups (OR = 1.24, 95% CI: 0.97-1.51, p > 0.05).

Conclusions: This study found that higher-cost nursing per bed was associated with significantly lower intensive care unit and in-hospital mortality rates, as well as fewer high length of stay outliers, but had no significant effect on readmission to the intensive care unit. .

Keywords: Cost; Intensive care unit; Nursing; Quality of care; Workload.

MeSH terms

Belgium
Hospital Mortality
Hospitals*
Humans
Intensive Care Units*
Length of Stay
Patient Readmission
Retrospective Studies