Grantee Profiles
Mary Blegen
Preventing Preventable Errors: Does the Composition of Nurses Matter?
A Conversation with Dr. Mary Blegen about "Quality Care on Acute Inpatient Units"
How critical is the composition of hospital nurses for reducing medical errors? That's the question that INQRI researcher Mary Blegen at the University of California at San Francisco is attempting to answer. Blegen, professor and Director of the Center for Patient Safety, and her research team, which includes an economist, a health services researcher, and a practicing nursing executive, have been trying to quantify the extent to which nurse staffing levels and/or training of nurses affect outcomes for pressure ulcers (also known as bedsores), failure to rescue, and hospital-acquired infections, preventable conditions which cost billions of dollars a year and trigger tens of thousands of deaths. With the Centers for Medicare and Medicaid Services set to have Medicare stop paying hospitals for preventable medical errors in October 2008, Blegen and her team hope the results of their research will guide hospitals and policymakers in determining how best to keep patients safe and prevent these problems.
"There is very little research out there now that truly helps inform decisions on staff resources and who to put on the team to do the job," says Blegen. "We all recognize that there is a major problem with the safety of care in hospitals. Nurses are the final defense against errors as they are the ones with the patient most of the time and are in the best position to notice when things are going wrong. But if you don't have enough nurses on staff, you can't do that job very well."
That is why Blegen is focusing on errors with the highest incidence rates – pressure ulcers and failing to rescue patients who come into the hospital for treatment of one problem and then suddenly develop other problems and take a turn for the worse. Pressure ulcers alone cost the health system about $1.3 billion a year and while Blegen notes that they are completely preventable conditions, it's become almost acceptable that patients will get them when they are in the hospital for a lengthy period. That attitude will have to change this fall, when Medicare will no longer pay hospitals for the care that patients who develop preventable pressure ulcers need.
Blegen is collecting data from 58 academic health centers that will involve about 1.6 million patient discharges. Her findings should provide data on what it will take to reduce the rate of pressure ulcers. The kinds of questions she is looking to find answers to: Is it the hours per day a nurse spends on the unit that affects the prevalence of pressure ulcers, or is the training composition or skill mix of the team what makes the biggest difference for keeping patients healthy? She also is asking the same questions about how to curb hospital-acquired infections. "We hope to be able to show the link between the level of nurse staffing and outcomes of patients being cared for."
Blegen's research will also help guide a growing number of states that are considering setting mandatory nurse patient staffing ratios to address patient safety gaps amid attempts by hospitals to cut staff due to cost pressures. California was the first state to mandate minimum nurse/patient ratios for hospitals. Other states are considering doing the same. "These laws are being frantically passed without any real research behind them or knowledge of their impact," says Blegen. She says she hopes her research and that of others in the INQRI portfolio who are looking at nurse-sensitive performance measures such as David Thompson of Johns Hopkins University and Sean Clarke of University of Pennsylvania will help build a body of knowledge that hospital administrators need to guide them in structuring a strong health care team to achieve the best outcome for the patient.
For more information on this project, contact Dr. Mary Blegen at .