Massachusetts ICU nurse staffing regulations did not improve patient mortality and complications
The findings were a surprise, as researchers thought they would find decreased complications and mortality rates for critically ill patients.
In 2014, Massachusetts lawmakers passed a law requiring a 1:1 or 2:1 patient-to-nurse staffing ratio in intensive care units in the state, as guided by a tool that accounts for patient acuity and anticipated care intensity.
The regulations were intended to ensure patient safety in the state's ICUs, but new research led by physician-researchers at Beth Israel Deaconess Medical Center found the staffing regulations were not linked to improved patient outcomes.
The findings ran counter to what the researchers had anticipated, as they hypothesized that the regulations would result in decreased complications and mortality for critically ill patients, at least when compared to patients admitted to ICUs elsewhere in the country. But that simply wasn't the case.
The team examined 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.
The Massachusetts regulations mandated 1:1 or 2:1 patient-to-nurse ratios based on patient acuity and anticipated care intensity. Academic ICUs were required to comply with the new regulations by March 31, 2016, while all other hospitals had until January 31, 2017.
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. Other analyses looked at changes occurring at community, non-academic ICUs and among 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.
There were modest increases in ICU nurse staffing ratios in Massachusetts before and after the mandate's implementation, with a change from 1.38 patients per nurse to 1.28 patients per nurse.
But 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 team 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.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
