Matching Registered Nurse services with changing care demands (Match RN ): study protocol of a natural experiment multi-centre study.

AIM: The aim of this study was to examine how patient safety indicators and processes and structures of nursing care have changed since the 2012 introduction of Swiss Diagnosis-Related Groups.

BACKGROUND: Diagnosis-Related Groups have been implemented worldwide; yet, research findings regarding their impact on efficiency and quality of care remain inconsistent. The Matching Registered Nurse Services with Changing Care Demands study will assess how structures, processes and patient and nurse outcomes have changed in Swiss acute care hospitals since the introduction of Swiss Diagnosis-Related Groups.

DESIGN: A multi-centre observational study nested in a natural experiment.

METHODS: To explore the effect of implementing Diagnosis-Related Groups in Switzerland we will compare nurse and patient survey data from 2010 with data from 2015 and eventually from 2017. Initially, we will match survey data from 78 medical and surgical units of 21 hospitals that participated in 2010 and 2015. Study variables related to structures and processes of nursing care (e.g. staffing/skill mix level, nurse work environment, rationing of nursing care), as well as patient and nurse outcomes, were assessed with well-established instruments. In 2017, a follow-up survey will be conducted to explore long-term implications. Furthermore, 6 years' medical and surgical patient discharge data (collected 2010-2015) will be analysed to assess changes in the severity of patient illness, length of stay and selected patient safety indicators.

DISCUSSION: This study's results will provide evidence regarding Diagnosis-Related Groups influences on Swiss nursing services and patient safety outcomes.