Examining the role of hospital setting and nurse staffing on length of stay among patients with chronic heart failure

Open Access
Meinert, Cayla D
Area of Honors:
Health Policy and Administration
Bachelor of Science
Document Type:
Thesis Supervisors:
  • Patricia Y Miranda-Hartsuff, Thesis Supervisor
  • Dr. Rhonda Be Lue, Honors Advisor
  • Nurse staffing
  • Hospital location
  • Chronic heart failure
  • Length of stay
With increased awareness about the implications of quality failures and the direct role nurses play in the delivery of care, research examining the impact of nurse staffing on outcomes, such as length of stay (LOS), has increased significantly over the past decade. While quality can be measured in a variety of ways, LOS is one important indicator of hospital efficiency that is often associated with quality of care. The purpose of this study is to provide a comprehensive analysis of the role of nurse staffing on length of stay for patients with congestive heart failure in rural, urban teaching, and urban non-teaching hospital settings. This study used data from the AHRQ’s Healthcare Cost and Utilization Project 2011 National Inpatient Sample. The sampling framework for this study was limited to discharges containing a diagnosis of chronic heart failure (N=81,791). Using Stata Version 13, a negative binomial regression was conducted to primarily examine the association of LOS with nurse staffing/skill mix while controlling for covariates such as hospital location/teaching status, admission type, bed size, and patient-level demographics. Patients discharged with chronic heart failure had an average LOS of 6.9 days, which did not significantly vary by nurse staffing quartiles but did significantly vary by hospital location from 5.5 days (rural hospitals) to 7.0 days (urban teaching hospitals), unadjusted for covariates (p<0.0001). Findings were similar in fully-adjusted models. There were no differences in LOS by nurse quartiles, however the LOS was significantly lower among rural and urban non-teaching hospitals relative to urban teaching hospitals (0.75 and 0.95 times the incidence, respectively). Comparing patient outcomes, quality of care, and nurse staffing levels in different hospital settings can give insight to the best and most efficient practices and help hospitals ensure they are providing the best quality of care to patients with chronic heart failure.