Author Identifier

Christine Duffield

ORCID : 0000-0001-6534-8743

Document Type

Journal Article

Publication Title

Journal of Advanced Nursing





First Page


Last Page





School of Nursing and Midwifery




Department of Health Health Research Board


Murphy, A., Griffiths, P., Duffield, C., Brady, N. M., Scott, A. P., Ball, J., & Drennan, J. (2021). Estimating the economic cost of nurse sensitive adverse events amongst patients in medical and surgical settings. Journal of Advanced Nursing, 77(8), 3379-3388.


Aims: To identify the costs associated with nurse sensitive adverse events and the impact of these events on patients’ length of stay. Design: Retrospective cohort study using administrative hospital data. Methods: Data were sourced from patient discharge information (N = 5544) from six acute wards within three hospitals (July 2016–October 2017). A retrospective patient record review was undertaken by extracting data from the hospitals’ administrative systems on inpatient discharges, length of stay and diagnoses; eleven adverse events sensitive to nurse staffing were identified within the administrative system. A negative binomial regression is employed to assess the impact of nurse sensitive adverse events on length of stay. Results: Sixteen per cent of the sample (n = 897) had at least one nurse sensitive adverse event during their episode of care. The model revealed when age, gender, admission type and complexity are controlled for, each additional nurse sensitive adverse event experienced by a patient was associated with an increase in the length of stay beyond the national average by 0.48 days (p =.001). Applying this to the daily average cost of inpatient stay per patient (€1456), we estimate the average cost associated with each nurse sensitive adverse event to be €694. Extrapolating this nationally, the economic cost of nurse sensitive adverse events to the health service in Ireland is estimated to be €91.3 million annually. Conclusion: These potentially avoidable events are associated with a significant economic burden to health systems. The estimates provided here can be used to inform and prepare the way for future economic evaluations of nurse staffing initiatives that aim to improve care and safety. Impact: As many of these nurse sensitive adverse events are avoidable, in addition to patient benefits, there is a potential substantial financial return on investment from strategies such as improved nurse staffing that can reduce their occurrence.



Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Research Themes


Priority Areas

Safety and quality in health care

Included in

Nursing Commons