What Ten Simple Interventions Cost and What They Save: A Cost Analysis of Adopting Safewards on a 20-Bed Behavioral Health Unit, Under Two Effect Assumptions
Student Name
American College of Education
NUR5113: Management of Financial Resources in Nursing
Module 5 Assignment
Instructor Name
June 1, 2027
The Question and the Perspective
The October variance analysis in Module 3 traced much of the unit's overspending to aggression: two assaultive patients drove extra registered nurse hours, observation hours and overtime. The unit's leaders proposed adopting Safewards, a model for reducing conflict and containment on psychiatric wards, and the chief nursing officer asked whether it would pay for itself. This paper answers that question.
Every economic evaluation must state whose costs and benefits it counts and over what period. Drummond et al. (2015) stress that the perspective determines which costs and consequences belong in the analysis, and that a narrow perspective can make an intervention look better or worse than it is for society. This analysis takes the hospital's perspective, counting costs the hospital pays and savings it receives, over the first year of implementation, with a note on the second year. Benefits to patients that do not produce hospital savings, such as fewer frightening experiences of restraint, are reported but not priced.
The Intervention and Its Evidence
Safewards is a set of ten interventions aimed at the relationships and routines that trigger conflict on psychiatric wards, such as agreeing mutual expectations between staff and patients, softening the words used when bad news or limits are delivered, talking staff down from conflict rather than escalating it, and a daily mutual help meeting among patients. In a cluster randomized trial across 31 wards, wards using it recorded 15% fewer conflict events than control wards and fewer containment events, a category that covers special observation, restraint and seclusion, with a 23.2% reduction against wards that received a staff wellness program instead (Bowers et al., 2015). In a later implementation across 13 wards in Victoria, Australia, seclusion rates fell by 36% by the one-year follow-up while comparison wards saw no similar reduction (Fletcher et al., 2017).
The evidence is strong enough to justify a trial on this unit, but not strong enough to assume the same effect. The randomized trial was conducted in England, over a short period and with research support. The analysis therefore uses the trial's effects as the base case and half of them as a conservative case.
Costs
First-year costs fall into four categories. Training: each of 58 staff, including registered nurses, mental health technicians, social workers and therapists, will attend an eight-hour training day, 464 hours at an average loaded cost of $45 an hour including backfill, or $20,880. Champions: two registered nurses will each spend 10% of their time, about 208 hours a year each, leading implementation, checking fidelity and coaching peers, at $46.50 an hour plus 30% benefits, or $25,147. Materials: boards for mutual expectations and discharge messages, calm-down kits and printed resources, $3,500. Facilitation: an experienced external trainer for the first two training days and two follow-up visits, $8,000. The total first-year cost is $57,527.
In the second year, costs fall to about $36,000, covering the champions' time, a four-hour refresher for all staff and training for new hires.
Outcomes and Savings
Savings are estimated by applying the trial's effects to the unit's own baseline data. Of last year's one-to-one observation hours, 2,100 were ordered for environmental reasons that the renovation proposed in Module 4 would remove, leaving 7,760 hours ordered for clinical reasons that Safewards could affect. A 23.2% reduction would avoid about 1,800 hours, which at the $33.60 average cost per observation hour saves $60,491. The unit had 130 restraint and seclusion episodes; at 23.2% fewer, about 30 episodes would be avoided, and at an estimated $420 per episode in staff time, physician assessment and documentation, the saving is $12,667. The unit had 9 workers' compensation claims from assaults on staff, averaging $11,400 each; a 15% reduction in conflict would avoid about 1.35 claims a year, saving $15,390.
Total base-case savings are $88,548 in the first year, against costs of $57,527, a net saving of $31,021. Counting restraint, seclusion and intramuscular medication given in an emergency together, the unit had 340 containment events last year, so the base case avoids about 79 of them while saving money. In health economic terms, an intervention that improves outcomes and costs less is dominant. In the base case the question is not whether the unit can afford Safewards but why it has not adopted it already.
The Conservative Case
If the unit achieves only half of the trial's effects, first-year savings fall to $44,274, and the program costs $13,253 more than it saves. It would still avoid about 39 containment events, at a net cost of about $336 for each event avoided. In the second year, with costs of $36,000, the conservative case turns positive, saving about $8,274, and the base case would save about $52,548.
The conservative result changes the framing, not the recommendation. A cost of $336 to spare a patient one episode of restraint, seclusion or forced medication is small compared with what those events cost patients and staff, and by the second year the program pays for itself even under pessimistic assumptions. The analysis also excludes savings that are likely but hard to measure, such as lower turnover among staff who are assaulted less often, which Module 3 showed is one driver of the unit's overtime costs.
Who Pays and Who Saves
The savings do not all land in the same budget, which matters for how the proposal is received. The unit's own budget pays for the champions' time and the training hours, but it receives only the observation and restraint savings, about $73,000 in the base case. The workers' compensation savings accrue to the hospital's risk management budget, and any reduction in turnover would show up in human resources costs for recruiting and orientation. Seen only from the unit's budget, the program still saves money in the base case, but in the conservative case the unit would carry a first-year cost of about $21,000 while another department received part of the benefit. The nursing director will therefore ask the chief financial officer to fund the first year's training from a hospital-level safety budget rather than the unit's operating budget, and will report the savings by department so that each budget holder can see its share. Cost analyses that ignore this split often produce good recommendations that stall because the department asked to pay is not the one that benefits.
Limits and Recommendation
The analysis borrows effects from studies in other countries and applies them to one unit's small numbers, where a single assaultive patient can move a whole year's figures. Costs per restraint episode are estimates from staff time rather than from an accounting study. The results should therefore be read as a reasoned forecast, not a promise. The recommendation is to adopt Safewards for a one-year trial, with fidelity checked quarterly by the champions and the unit's observation hours, containment events and staff injuries reported monthly against the baseline, so that the second year's decision rests on the unit's own results.
References
Bowers, L., James, K., Quirk, A., Simpson, A., Stewart, D., & Hodsoll, J. (2015). Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial. International Journal of Nursing Studies, 52(9), 1412-1422. https://doi.org/10.1016/j.ijnurstu.2015.05.001
Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes (4th ed.). Oxford University Press.
Fletcher, J., Spittal, M., Brophy, L., Tibble, H., Kinner, S., Elsom, S., & Hamilton, B. (2017). Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement. International Journal of Mental Health Nursing, 26(5), 461-471. https://doi.org/10.1111/inm.12380
How this NUR 5113 Module 5 example is structured
NUR 5113 Module 5 commonly compares the costs and outcomes of a nursing intervention in a cost analysis; your classroom's instructions decide the type of analysis and the perspective. This example states the perspective and time horizon, describes the intervention and its evidence, itemizes costs, estimates outcomes and savings from published effects applied to local data, reports net cost and cost per event avoided, and tests the conclusion under a less favorable assumption.
NUR5113 Module 5 questions, answered
What does NUR5113 Module 5 usually ask for?
NUR5113 Module 5 commonly asks you to compare the costs and outcomes of a nursing intervention, often as a cost-benefit or cost-effectiveness analysis. Your classroom's instructions decide the type of analysis, the perspective and whether a table is required.
Where do I get the effect size for my intervention?
From the best published evidence, ideally a randomized trial or systematic review. Apply it to your unit's own baseline numbers, and test a more conservative effect because results in routine practice are often smaller than in trials.
What if my intervention does not save money?
Report the net cost and express it per outcome gained, such as cost per restraint episode avoided. Many worthwhile nursing interventions cost something; the analysis shows what that money buys.
Write yours, or have the desk draft it
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