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Yet LOS alone was not a sufficient explanation for HAPU rates.
Even with low HAPU prevalence rates (<3 percent) and high rates of admission risk assessment (>98 percent), differences in patients and in structure and processes of care were identified that impacted HAPU prevalence.
Our data on shorter LOS were consistent with others who have reported the association between LOS and HAPU (Russo, Steiner, and Spector 2008; Lyder et al.
Increasing nursing hours and/or licensed hours could maintain or reduce the number of HAPU-II+; however, to date, the literature linking HAPU prevalence and nurse staffing has produced mixed results.
In contrast to our findings associating higher patient (bed) turnover with lower HAPU, recent work by Park et al.
Longer LOS is clinically related to HAPU risk for individual patients, while patient turnover describes the level of activity on the unit.
The study was conducted during a significant economic downturn when RN voluntary turnover was low and unrelated to HAPU findings.
Finally, the findings from this study demonstrate the importance of nursing experience, with lower HAPU rates predicted by a combination of more experienced staff and fewer contract nurses, mitigating the effects of unit/ patient characteristics on HAPU.
While HAPU rates at the time of this study were low, CALNOC data show that they have decreased over time.
Importantly, the predictive models show that RN workload, expertise, and clinical processes of care (risk assessment) can be manipulated to mitigate HAPU prevalence.
55 HAPU clinical process (N = 789 units) Percent of patients with risk assessment within 98.