Association between patient classification systems and nurse staffing costs in intensive care units: An exploratory study

Siv K Stafseth; Tor Inge Tønnessen; Lisbeth Fagerström

doi:10.1016/j.iccn.2018.01.007

Association between patient classification systems and nurse staffing costs in intensive care units: An exploratory study

Intensive Crit Care Nurs. 2018 Apr:45:78-84. doi: 10.1016/j.iccn.2018.01.007.

Authors

Siv K Stafseth¹, Tor Inge Tønnessen², Lisbeth Fagerström³

Affiliations

¹ Dept. of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway. Electronic address: siv.stafseth@oslo-universitetssykehus.no.
² Division of Emergencies and Critical Care, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway. Electronic address: t.i.tonnessen@medisin.uio.no.
³ Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway and Professor at Åbo Akademi University, Finland. Electronic address: lisbeth.fagerstrom@hsn.no.

PMID: 29402682
DOI: 10.1016/j.iccn.2018.01.007

Abstract

Objectives: Nurse staffing costs represent approximately 60% of total intensive care unit costs. In order to analyse resource allocation in intensive care, we examined the association between nurse staffing costs and two patient classification systems: the nursing activities score (NAS) and nine equivalents of nursing manpower use score (NEMS).

Research methodology/design: A retrospective descriptive correlational analysis of nurse staffing costs and data of 6390 patients extracted from a data warehouse.

Setting: Three intensive care units in a university hospital and one in a regional hospital in Norway.

Main outcome measures: Nurse staffing costs, NAS and NEMS.

Results: For merged data from all units, the NAS was more strongly correlated with monthly nurse staffing costs than was the NEMS. On separate analyses of each ICU, correlations were present for the NAS on basic costs and external overtime costs but were not significant. The annual mean nurse staffing cost for 1% of NAS was 20.9-23.1 euros in the units, which was comparable to 53.3-81.5 euros for 1 NEMS point.

Conclusion: A significant association was found between monthly costs, NAS, and NEMS. Cost of care should be based on individual patients' nursing care needs. The NAS makes nurses' workload visible and may be a helpful classification system in future planning and budgeting of intensive care resources.

Keywords: Hospital costs; Intensive care units; NAS; NEMS; Nine equivalents of nursing manpower use score; Nursing activities score; Nursing staff; Workload.

MeSH terms

Adult
Costs and Cost Analysis
Female
Follow-Up Studies
Humans
Intensive Care Units* / economics
Intensive Care Units* / statistics & numerical data
Male
Middle Aged
Norway
Nurses / economics*
Nurses / statistics & numerical data
Personnel Staffing and Scheduling / economics*
Retrospective Studies
Workforce