The descriptive study was designed to examine the relationship between the hospitalized patient's medical diagnosis and the hospital nursing workload. The study examined selected patient related factors that influence variability in the nursing workload. The factors were: patient age; patient severity of illness; patient length of hospital stay; and patient nursing care requirements.
The study hospital was a tertiary care medical center in the northeast. The sample was comprised of 5,627 individual patient cases representing the top twenty (high volume) diagnosis related patient populations (DRGs).
Data for the study were extracted from existing hospital and nursing information systems at the study hospital. The data were separated by patient population (DRG). Each patient population separately and patient care in general (aggregated DRGs) were analyzed to develop predictive but parsimonious models for nursing workload.
Findings indicated significant relationships existed between DRGs, hospital nursing workload and the study factors. Significant differences were found between mean nursing hours for different patient age categories for some DRGs. A very strong relationship was found between DRGs, mean nursing hours and patient length of hospital stay, total stay, and stay on different types of hospital units. A moderately strong relationship was found between DRGs, mean nursing hours and patient severity of illness as measured by DRG relative weights. Significant differences were found between mean nursing hours for DRG inlier and outlier patient groupings. Significant differences were found in mean nursing hours for elements of nursing care requirements between and within DRGs and different types of hospital units.
To curb spiraling health care costs, hospital payment rates are increasingly being predetermined based on the patient's medical diagnosis. Hospital nursing care services are not predetermined. The same rate is charged to each patient regardless of the amount of nursing care received. Efforts are underway to define a variable payment rate for hospital nursing care. These study findings contribute to those efforts by helping to define how selected patient related factors influence variability in the hospital nursing workload.
