Table 4.
Cost of Significant Nursing Interventions for Heart Failure by Use Rate (N = 1,435, Median Hospital Cost=$10,454)
| Use Levels | Use Rate/ 24 Hours* | Proportional Change in Cost | Overall p | p for use levels | Change in Median Cost† in Dollars per Hospitalization | |
|---|---|---|---|---|---|---|
| Total number of different nursing interventions | Count of interventions | 1.027 | <.0001 | $289.33 | ||
| Type of nursing intervention (% receiving at least once during hospitalization) | ||||||
| Fluid Management (99.7%) Promotion of fluid balance and prevention of complications resulting from abnormal or undesired fluid levels.‡ | Highest 25% | 6.08 | 0.917 | .0176 | .0036 | −$870.12 |
| Next highest 25% | 3.31 | 0.945 | .0678 | −$571.33 | ||
| Next lowest 25% | 2.10 | 0.926 | .0046 | −$772.83 | ||
| Lowest 25% | 1.19 | — | ||||
| Routine Care (96.7%) Provision of care to the adult patient newly admitted to an inpatient setting, such as call light within reach, asking about sleep, giving AM care, observing | Highest 25% | 7.71 | 0.925 | .0108 | .1151 | −$781.54 |
| Next highest 25% | 7.02 | 0.998 | .9671 | −$20.89 | ||
| Next lowest 25% | 5.98 | 0.920 | .0919 | −$831.71 | ||
| Lowest 25% | 2.63 | — | ||||
| IV Therapy (94.5%) Administration and monitoring of intravenous fluids and medications | Top third | 6.50 | 1.084 | .0108 | .1687 | $867.31 |
| Middle third | 3.02 | 0.997 | .9569 | −$30.27 | ||
| Lower third | 1.32 | 1.052 | .3405 | $548.10 | ||
| No use | 0 | — | ||||
| Pressure Ulcer Care (89.3%) Facilitation of healing in pressure ulcers | Top third | 0.90 | 0.786 | <.0001 | <.0001 | −$2232.30 |
| Middle third | 0.38 | 1.037 | .4767 | $390.80 | ||
| Lower third | 0.22 | 1.107 | .0285 | $1115.67 | ||
| No use | 0 | — | ||||
| Discharge Planning (84.0%) Preparation for moving a patient from one level of care to another within or outside the current health care agency | Top third | 1.23 | 0.959 | .0301 | .2645 | −$424.97 |
| Middle third | 0.91 | 1.016 | .6562 | $165.43 | ||
| Lower third | 0.52 | 0.944 | .1039 | −$581.20 | ||
| No use | 0 | — | ||||
| Oral Health Restoration (83.5%) Promotion of healing for a patient who has an oral mucosa or dental lesion | Top third | 2.16 | 1.019 | <.0001 | .6029 | $199.47 |
| Middle third | 1.75 | 0.893 | .0017 | −$1122.63 | ||
| Lower third | 0.81 | 0.903 | .0058 | −$1015.65 | ||
| No use | 0 | — | ||||
| Fall Prevention: adult (83.3%) Instituting special precautions with patients at risk from falling | Top third | 3.89 | 1.002 | .0001 | .9675 | $15.69 |
| Middle third | 1.87 | 0.940 | .0718 | −$631.43 | ||
| Lower third | 0.19 | 1.059 | .1056 | $612.10 | ||
| No use | 0 | — | ||||
| Bowel Management (76.9%) Establishment and maintenance of a regular pattern of bowel elimination | Top third | 2.88 | 0.960 | .0040 | .2290 | −$418.95 |
| Middle third | 1.56 | 0.925 | .0171 | −$784.44 | ||
| Lower third | 0.46 | 1.023 | .4215 | $241.10 | ||
| No use | 0 | — | ||||
| Infection Protection (73.2%) Prevention and early detection of infection in a patient at risk | Top third | 3.08 | 0.939 | .0038 | .0693 | −$636.34 |
| Middle third | 2.56 | 0.887 | .0002 | −$1180.31 | ||
| Lower third | 1.03 | 0.943 | .0658 | −$594.03 | ||
| No use | 0 | — | ||||
| Medication Management (10.8%) Facilitation of safe and effective use of prescription and over-the-counter drugs | Top third | 1.58 | 0.806 | <.0001 | <.0001 | −$2026.69 |
| Middle third | 0.40 | 1.007 | .8803 | $74.49 | ||
| Lower third | 0.13 | 1.220 | .0001 | $2295.47 | ||
| No use | 0 | — | ||||
*
The change in the log of hospital cost per unit change for the corresponding predictor.
†
The ratio (change in the log of hospital cost per unit change for the corresponding predictor) minus one multiplied by the median hospital cost.
‡
Definitions from Dochterman and Bulechek (2004). Nursing Interventions Classification (NIC), 4th edition, Mosby Inc.
Bold face indicates statistically significant p values (p≤.05).