Massachusetts ICU Nurse Staffing Regulations Had Little Impact.
Concerned that inadequate nurse staffing may lead to patient harm, Massachusetts lawmakers signed a mandate into law in 2014 stipulating a 1:1 or 2:1 patient-to-nurse staffing ratio in intensive care units (ICU), as guided by a tool that accounts for patient acuity and anticipated care intensity.
Now, a new study co-authored by a School of Public Health researcher finds these ICU staffing regulations led to only modest staffing increases, and were not associated with improved patient outcomes.
The study, published in Critical Care Medicine, found that the average patient-to-nurse ratio went from 1.38 patients per nurse to 1.28 patients per nurse after the law went into effect, while the risk of mortality and the risk of complications in Massachusetts’ ICUs remained stable.
“The Massachusetts regulations resulted in only minimal changes in nurse staffing, which likely explains the lack of changes to patient outcomes,” says study senior author Allan Walkey, associate professor of health law, policy & management. “Our results suggest that Massachusetts hospitals may have had adequate ICU nurse staffing prior to the law.”
The team looked at records from 246 medical centers nationwide, comparing patient outcomes in Massachusetts’ six academic ICUs with outcomes in 114 out-of-state academic ICUs before, during, and after the state mandate was implemented. Academic ICUs were required to comply with the new regulations by March 31, 2016, while all other hospitals had until January 31, 2017.
Analyzing tens of thousands of ICU admissions records, the researchers focused on the change in mortality rates for patients in Massachusetts’ academic ICUs before and after the mandate was implemented, compared with patients hospitalized in out-of-state hospitals. In other analyses, they looked at data from community, non-academic ICUs, as well as a group of the sickest patients who received support from a ventilator. The team also analyzed the rate of complications, including central line-associated bloodstream infections, catheter-associated urinary tract infections, hospital-acquired pressure ulcers, and patient falls with injury.
The researchers found modest increases in ICU nurse staffing ratios in Massachusetts before and after mandate implementation, with a change from 1.38 patients per nurse to 1.28 patients per nurse. However, these increases were not significantly higher than staffing trends in states without state-mandated ICU staffing regulations, suggesting nurse staffing increases in Massachusetts could not be attributed to the state legislation. The researchers also found that risk of mortality and risk of complications in Massachusetts’ ICUs remained stable after the law’s implementation, with no significant difference in trends compared to out-of-state hospitals.
“Our findings show the need to thoroughly evaluate likely impacts of new regulations like the Massachusetts nursing law prior to instituting complex policy changes,” Walkey says.
The study was led by Anica C. Law of Beth Israel Deaconess Medical Center, and co-authored by Jennifer P. Stevens of Beth Israel Deaconess Medical Center and Samuel Hohmann of Viziant Center for Advanced Analytics.