Research has shown that while increasing the number of nurses in hospitals may raise initial costs, these additional RNs may well result in overall cost savings. In a recent observational study, Shever and colleagues sought to determine the effect on hospital costs of "increased nursing surveillance" of patients at risk for falling-assessing a patient's risk and monitoring her or his ability to carry out daily activities, among other factors.

Data for 10,187 patients ages 60 years and older hospitalized between 1998 and 2002 were collected at a large Midwestern medical center. Patients were divided into two groups: 49% received surveillance fewer than 12 times per day (the low-surveillance group) and 51% received surveillance 12 or more times per day (the high-surveillance group). High surveillance cost a median of $191 more per hospitalization than low surveillance. Yet the high-surveillance group did reduce the number of falls: 157 falls compared with 324 in the low-surveillance group.

The authors concluded that, although high surveillance increased costs by almost $200, increased care may avert fall-related hospitalization, leading to an estimated savings of $17,483. While these results may not be generalizable (the setting was limited to one large hospital), more studies of this kind should be conducted so that nurses can assess whether certain interventions might provide benefits not only to health but also to costs.

Subhashni D. Singh Joy