Page 128 - Encyclopedia of Nursing Research

CRITICAL CARE nURSInG RESEARCH n 95

entire profession for the future. Questions of have cost and resource savings as we move
appropriate skill mix cannot be determined to “best demonstrated practices.”
solely on a cost per hour of service, cost per Finally, we must move toward a cost– C
case, or cost per diagnostic-related group benefit analysis model that incorporates the
basis. new studies are needed that will com- outcomes of practice. This aspect has been
bine traditional cost analysis with differential especially elusive, given the “generic” and
outcome analysis to secure a larger picture of group nature of nursing practice. With mul-
the “true cost–benefit ratio” for specific nurs- tiple nursing providers impacting a patient’s
ing models. care, how do we separate the relative contri-
The most notable characteristic of cost butions of each person or each subspecialty
analysis studies is the variety of definitions, of nursing practice that a patient may expe-
variables, and measurement tools used in the rience in the course of their care from con-
studies. Length of stay and nursing turnover tributions of other disciplines? Additionally,
are major variables included in cost studies. we need to quantify the costs of increased
A major area of dispute for costing studies is patient mortality and failure to rescue asso-
the lack of a standard acuity measure because ciated with changes in nurse/patient ratios.
of the proprietary nature of most acuity sys-
tems. Cost and efficiency of nursing proce- Mary L. Fisher
dures or treatments continue to be studied.
Another important area for cost analysis is
to evaluate cost differences among profes-
sional practice models. However, most of CritiCal Care
these studies use proprietary practice mod-
els that are difficult to duplicate in other set- nursing researCh
tings. variables are identified in these studies
that do impact nursing costs, such as nursing
turnover, ratio of productive to nonproduc- In the history of nursing, the development
tive hours, and nursing satisfaction. of the specialty of critical care is fairly
Given the growth of capitation, cost anal- recent, paralleling the growth and devel-
ysis of nursing services will need to take new opment of intensive care units (ICUs) in the
directions. As critical pathways (benchmark 1960s and 1970s. The first ICUs were areas
performance tools) evolve as care guides, the in the hospital designated for the care of
costs of pathway changes on nursing deliv- patients recovering from anesthesia who
ery, patient outcomes, and case costs must required close monitoring during a period
be calculated. What are the most efficient of physiological instability. Recognition
and effective pathways toward resolution of of the efficiency and effectiveness gained
a given health problem? What practice set- from segregating any patients who required
ting is appropriate for patients at each step intensive nursing care for a short period of
of the pathway? For example, when is it safe time was spurred by experiences in manag-
to transfer a fresh open heart patient from ing groups of critically ill patients, such as
critical care to a step-down environment? those injured in the Boston Coconut Grove
(Earliest transfer to a least costly delivery fire of 1942 and victims of the polio epidem-
mode saves money.) These calculations may ics of the 1950s (Lynaugh & Fairman, 1992).
be critical for institutions to secure managed- The development of the mechanical venti-
care contracts in a cost-competitive environ- lator and advances in coronary care led to
ment. Determining what activities can be recognition of the need for specialized skills
safely eliminated from a pathway without and knowledge bases among nurses caring
negatively impacting care outcomes will for these patients.