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Hospitals Cut Costs And Rns, But Effect On Quality Unclear Patients Happier With Care At Institutions Surveyed For Report

The jury is still out on whether hospital moves to cut costs by reducing the number of registered nurses are compromising quality of care, according to a study released Saturday.

Patient satisfaction improved in several major hospitals and health maintenance organizations that restructured their work forces and care systems, according to the report released by the Economic Policy Institute.

But while patients were happier with how quickly their call bells were answered and lab tests came back, it was uncertain whether “clinical quality is maintained (let alone enhanced) under restructuring efforts,” said the study on innovations in the medical workplace.

The Economic Policy Institute, a liberal think tank founded in 1986, is backed by grants from foundations, labor unions and other groups. Its founders included Robert Reich, the secretary of Labor.

The report’s author, Ann Greiner, who formerly worked for the New York State Nurses Association, said the health care industry “has been on a roller coaster ride for the last several years.”

“Registered nurses, who just four years ago were receiving significant salary increases and being wooed to hospitals with signing bonuses, are being handed pink slips,” she said.

There have been numerous hospital mergers in recent years, and many hospitals, including prestigious academic medical centers, have scrambled to reduce their beds and staffs under pressure from managed care companies to discount their prices.

Greiner conducted case studies of six major hospitals and an HMO: University of Michigan Medical Center in Ann Arbor; Kaiser Bellflower Hospital in Los Angeles; Mercy Hospital in Chicago; Paoli Memorial Hospital in suburban Philadelphia; St. Vincent Hospital in Indianapolis; an anonymous academic medical center on the West Coast; and the Harvard Community Health Plan in Boston.

“These organizations generally implemented change with great care … and tried to protect their employees from untoward effects,” she said. “Yet they still are not certain about the effect on clinical quality.”

She cautioned that other hospitals and HMOs are restructuring their work forces “much more rapidly with less employee training, creating a potential danger for patients who are sicker and leaving hospitals quicker than ever before.”

Many hospitals have sought to improve care by wider use of formal protocols or “clinical pathways” on how doctors and nurses should handle medical procedures and problems.

The unnamed academic medical center on the West Coast has realized $50 million in savings over five years by cutting its staff and “diluting the RN skill mix,” the report said.

It has gone from having 90 percent registered nurses to 65 percent RNs, using more aides to handle basic dressing changes, take vital signs and perform other low-skill chores.

The report recommends that hospitals pilot test any changes in their work force until they can prove that quality is not compromised. It also urges them to develop training curricula for the new generalists on their nursing staffs, to conduct competency tests of the workers, and to reexamine pay scales to make them more equitable.