Estimating nursing intensity and direct cost using the nurse-patient assignment

Area of Science:

• Healthcare Management
• Nursing Economics
• Health Informatics

Background:

• Direct nursing hours and costs are crucial for hospital financial management and quality assessment.
• Existing methods for calculating nursing intensity may be resource-intensive or lack granularity.
• Nurse-patient assignment (NPA) data is widely available across healthcare settings.

Purpose of the Study:

• To assess the feasibility of using NPA data to determine direct nursing hours and costs for individual inpatient-days.
• To evaluate NPA as a tool for establishing the intensity and economic value of nursing care.

Main Methods:

• Direct nursing care hours were collected for 11,582 patient-days at a university hospital (Jan 2004-June 2005).
• Nursing intensity was calculated using NPA data for each shift.
• Ordinary least squares regression compared NPA-derived nursing hours with directly measured hours at patient, unit, and hospital levels.

Main Results:

• NPA explained a significant portion of the variance in patient-level nursing intensity (day shift: R²=0.772; night shift: R²=0.824).
• Unit and hospital-level NPA estimates showed moderate correlations with direct nursing hours (day shift: R²=0.574-0.456; night shift: R²=0.633-0.579).

Conclusions:

• NPA provides a robust and accessible method for calculating individual patient nursing intensity.
• NPA data can be integrated into hospital billing systems for accurate allocation of nursing time and costs.
• NPA is valuable for pay-for-performance initiatives and benchmarking nursing intensity across healthcare facilities.