Patient and nurse staffing characteristics associated with high sitter use costs

This paper is a report of a study of the relationships between patient health conditions, nurse staffing characteristics and high sitter use costs.

Increasing recourse to patient sitters is a major cost concern to hospitals. To reduce these expenses, we need to understand better the factors associated with high sitter use costs.

From a cohort of 43,212 medical/surgical patients admitted to an academic health centre in Montreal (Canada) in 2007 and 2008, all 1151 patients who received a sitter were selected. We applied multivariate logistic regression, using the Generalized Estimating Equation framework, to estimate the relationships between patient health conditions, nurse staffing characteristics and being in the upper two quintiles of sitter costs, vs. the lower three.

The median sitter cost per patient, in Canadian dollars, was $772·35 (IQR = $1737·84); and $2397·00 (IQR = $3085·03) among the patients with high sitter use costs. In multivariate analyses, dementia, delirium and other cognitive impairments (OR = 1·49; 95% CI = 1·01-2·22) and schizophrenia and other psychoses (OR = 2·42; 95% CI = 1·08-5·76) increased the likelihood of high sitter use costs. In addition, every additional worked hour per patient per day by Registered Nurses (OR =0·33; 95% CI = 0·27-0·39) and by patient care assistants (OR = 0·11; 95% CI = 0·08-0·15) reduced the likelihood of high sitter use costs. Conclusion.  Circumstances of understaffing and patients having psycho-geriatric conditions are associated with high sitter use costs. Improving staffing and providing additional resources to support the care of psycho-geriatric patients may lower these expenses.