Nursing: a major hospital cost component

Selected studies of nursing costs demonstrate a wide variation per patient-day and per patient stay within the same DRG. These differences could reflect either actual differences in nursing practice or methodological differences in calculating practice costs. We examined several alternative methods to find hospital nursing costs of the same group of patients. Measures of patient illness--AS-SCORE severity of illness, Relative Intensity (RIMs), MacLeod nursing intensity, and a per diem measure--were compared for variations in nursing cost. Various definitions of nursing cost itself also were compared using the same patients. Two approaches to defining nursing cost elements--by nursing unit and by hands-on patient care-are discussed. Several nursing cost studies reporting data for DRG 121 (myocardial infarction with complications and/or comorbidity) were compared with our data. The nursing care costs in several studies of these same patients varied from $706 to $1,778 per stay (a 60 percent difference); reasons for these cost differences are discussed. It is suggested that at least part of this variability reflects methodological differences. Cost data should be reported carefully to facilitate comparisons with the results of other studies. Efforts should begin toward designing nursing cost studies using comparable measures and cost-finding methodologies.