Correlation between Quality of Care and Length of Hospital Stay in Neonatal Intensive Care Unit

Document Type : Original Article


1 School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran


Background: Length of hospital stay (LHS) is the most important and practical indicator in hospitals, which largely reflects the level of hospital performance and activity. It is also an important indicator for resource planning. Moreover, the quality of care can theoretically be related to LHS. The aim of this study was to investigate the relationship between LHS and quality of nursing care in the neonatal intensive care unit (NICU).
Methods: In this descriptive correlational study, the samples were 205 premature infants hospitalized in the NICU and 80 nurses working in the NICUs of selected hospitals. They were selected based on the inclusion criteria. The data were gathered using the demographics of nurses and neonates through Quality Patient Care Scale (QUALPAC). The data was analyzed in SPSS (version 21) using Spearman correlation coefficient.
Results: The results showed that 47.5% of the nurses were within the age range of 29-36 years and 68.8% of nurses had a working experience of 1-5 years. There was an inverse correlation between the neonate's length of stay and the quality of care (r=-0.507, P<0.0001).
Conclusion: The findings revealed an inverse relationship between the length of stay and quality of care. By improving the quality of care, we can decrease the LHS.


1. Reynolds LC, Crapnell T, Zarem C, Madlinger L, Tiltges L, Lukas K, et al. Nursing perceptions of clinical research in the neonatal intensive care unit. Newborn Infant Nurs Rev. 2013; 13(2):62-6.
2. Underwood MA, Danielsen B, Gilbert WM. Cost, causes and rates of rehospitalization of preterm infants. J Perinatol. 2007; 27(10):614-9.
3. Hamilton KE, Redshaw ME, Tarnow-Mordi W. Nurse staffing in relation to risk-adjusted mortality in neonatal care. Arch Dis Child Fetal Neonatal Ed. 2006; 92(2):99-103.
4. Lake ET, Hallowell SG, Kutney-Lee A, Hatfield LA, Del Guidice M, Boxer B, et al. Higher quality of care and patient safety associated with better NICU work environments. J Nurs Care Qual. 2016; 31(1):24.
5. Schulman J. Studying determinants of length of hospital stay. J Perinatol. 2006; 26(4):243-5.
6. Borhani F, Keshtgar M, Abbaszadeh A. Moral self-concept and moral sensitivity in Iranian nurses. J Med Ethics And Hist Med. 2015; 8:4.
7. Ramezanian MR, Gheibdoust H. Prioritization of the influential factors on health care services quality using a hybrid approach based on analytic network process (ANP) and fuzzy TOPSIS in public hospitals. J Hosp. 2010; 15(40):80-8.
8. NeishaboryM, Raeisdana N, Ghorbani R, Sadeghi T. Nurses' and patients' viewpoints regarding quality of nursing care in the teaching hospitals of Semnan university of medical sciences. Koomesh. 2011; 12(2):134-43.
9. Isis Montalvo MS. The national database of nursing quality indicators (TM)(NDNQI®). Online J Issues Nurs. 2007; 12(3):e1414-27.
10. Abbaszadeh A, Borhani F, Asadi N. Effects of health belief model-based video training about risk factors on knowledge and attitude of myocardial infarction patients after discharge. J Res Med Sci. 2011; 16(2):195-9.
11. Kandi Kele M, Kadivar M, Zeraati H, Ahmadnezhad E, Holakoui Naini K. Length of stay in NICU admitted infants and its effective factors at children's hospital medical center using survival analysis. Iran J Epidemiol. 2014; 10(1):25-32.
12. Neary E, Al-Assaf N, McDermott C, Sheehan K, Kirkham C, Corcoran D, et al. Planned hospital discharge: a strategy for reducing length of stay of 
very low birth weight (VLBW< 1500G) infants in NICU. Pediatr Res. 2011; 70(S5):698.
13. Freitas JS, Silva AE, Minamisava R, Bezerra AL, Sousa MR. Quality of nursing care and satisfaction of patients attended at a teaching hospital. Rev Lat Am Enfermagem. 2014; 22(3):454-60.
14. Borhani F, Mohamadi S, Roshanzadeh M. Moral distress and perception of futile care in intensive care nurses. J Med Ethics Hist Med. 2015; 8:2.
15. Lathrope P, Van Leeuwen M, Campbell D, Seiler K, Dvorak H, Schmelzel M, et al. Can improving continuity of care decrease length of stay in the NICU? Arusha, Tanzania: Evidence-Based Approach to Decreasing Length of Stay in the NICU; 2008.
16. Rothberg MB, Abraham I, Lindenauer PK, Rose DN. Improving nurse-to-patient staffing ratios as a cost-effective safety intervention. Med Care. 2005; 43(8):785-91.
17. Kornhauser M, Schneiderman R. How plans can improve outcomes and cut costs for preterm infant care. Managed Care. 2010; 19(1):28.
18. Parker L, Krueger C, Sullivan S, Kelechi T, Mueller M. Effect of breast milk on hospital costs and length of stay among very low-birth-weight infants in the NICU. Adv Neonatal Care. 2012; 12(4):254-9.
19. Pepler FT, Uys DW, Nel DG. Predicting mortality and length-of-stay for neonatal admissions to private hospital neonatal intensive care units: a Southern African retrospective study. Afr Health Sci. 2012; 12(2):166-73.
20. Pizzolorusso G, Turi P, Barlafante G, Cerritelli F, Renzetti C, Cozzolino V, et al. Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory
study. Chiropr Man Ther. 2011; 19(1):15.
21. Melnyk B, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, et al. Reducing premature infants' length of stay and improving parents' mental health outcomes with the creating opportunities for parent empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics. 2006; 118(5):e1414-27.
22. Lake ET, Hallowell SG, Kutney-Lee A, Hatfield LA, Del Guidice M, Boxer BA, et al. Higher quality of care and patient safety associated with better NICU work environments. J Nurs Care Qual. 2016; 31(1):24-32.
23. Thungjaroenkul P, Cummings G, Embleton A. The impact of nurse staffing on hospital costs and patient length of stay: a systematic review. Nurs Econ. 2007; 25(5):255-65.
24. Bhutta ZA, Khan I, Salat S, Raza F, Ara H. Reducing length of stay in hospital for very low birthweight infants by involving mothers in a stepdown unit: an experience from Karachi (Pakistan). BMJ. 2004; 329(7475):1151-5.
25. Lee SK, Aziz K, Singhal N, Cronin CM, James A, Lee DS, et al. Improving the quality of care for infants: a cluster randomized controlled trial. CMAJ. 2009; 181(8):469-76.
26. Shah S, Zemichael O, Meng HD. Factors associated with mortality and length of stay in hospitalized neonates in Eritrea, Africa: a cross-sectional study. BMJ Open. 2012; 2(5):792-801.
27. Borghans I, Kool RB, Lagoe RJ, Westert GP. Fifty ways to reduce length of stay: an inventory of how hospital staff would reduce the length of stay in their hospital. Health Policy. 2012; 104(3):222-33.