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Resource clusters and variation in physical restraint use.

PURPOSE
To describe (a) the extent of inter- and intrainstitutional variation in labor, capital, and process-of-care variables related to nursing service on U.S. adult acute and intensive care units; (b) the extent to which resource clustering exists; and (c) an analysis of resource cluster role that explains variation in physical restraint rates.


DESIGN
Descriptive.


METHODS
Staff at 82 adult acute care and 55 intensive care units from 40 randomly selected U.S. hospitals provided data about more than 100 capital, labor, and process variables via (a) a staff nurse survey, and (b) interviews with unit leaders and measurement of unit design. These data described resources during the period in which physical restraint rate was established via direct observation.


FINDINGS
Depending on the resource variable, 7% to 57% of hospitals in which more than one ICU was studied showed resource variation between their ICUs; the comparable statistics for adult acute units were 5% to 45%. Cluster analysis indicated a two-cluster solution for ICUs and a three-cluster solution for non-ICUs. ICU cluster assignment varied within 16% of hospitals in which more than one ICU was studied. Non-ICU cluster assignment varied within 20% of hospitals. Physical restraint use was best explained by patient characteristics, not resource clusters or individual resources.


CONCLUSIONS
Studies of outcomes that are the product of a single unit must include measurement of resources at the unit level, assuming equal resources among units of similar types within a hospital is unwarranted. Further research regarding the effect of resource clusters on nurse sensitive outcomes is suggested.