Graduation Year


Document Type




Degree Granting Department

Public Health

Major Professor

James Studnicki, Sc.D.

Committee Member

Stephen Luther, Ph.D.

Committee Member

Skai Schwartz, Ph.D.


adverse events, complication, expense, indicator, quality


Objective: To investigate the association between hospital investment in human resources variables and patient safety, specifically after surgery adverse events in Florida hospitals. We performed the analysis to identify the association of after surgery complication rates with full time equivalent employees (FTEs) per admission and per patient day, expenses per admission and per patient day and, the percent of total operating expense accounted for by payroll expenses.

Design: A cross sectional analysis using inpatient hospital discharge data and financial data from seventy short-term general hospitals, both for-profit and not-for-profit.

Methods: Discharge data from year 2000 was obtained from Agency for Health Care Administration (AHCA). This data was used to calculate Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) related to after surgery complications in 840,945 hospital discharge records from 70 short-term general hospitals across the state of Florida. The predictor variables include: payroll expenditures per admission, payroll expenditures per patient day, personnel (FTE) per admission, personnel (FTE) per patient day and payroll expense as a percent of total operating expenses.

Main outcome measures: Nine patient safety indicators defined by AHQR and specific to after surgery complications: complications of anesthesia, foreign body left during procedure, postoperative hemorrhage or hematoma, postoperative physiologic and metabolic derangement, postoperative pulmonary embolism or deep vein thrombosis, postoperative respiratory failure, postoperative sepsis, postoperative wound dehiscence.

Results: Patient safety indicator rate showed an inverse relationship with the percent of total operating expense represented by payroll, Personnel per patient day and personnel per admission. The patient safety indicators showing significant relationship with hospital human resource characteristics are postoperative hemorrhage or hematoma (p=0.0002), postoperative hip fracture (p<0.0001), and postoperative sepsis (p=0.0371).

Conclusion: Human resource investment is positively related to favorable outcomes, although the effect varies across the type of outcomes.