Inpatient Mortality

Low levels of nurse and nursing support staffing are associated with increased inpatient mortality, according to a study published online Aug in BMJ Quality & Safety. Jack Needleman, Ph.D., from the Fielding School of Public Health at the University of California in Los Angeles, and colleagues examin the association of inpatient mortality with patients’ cumulative exposure to shifts with low registered nurse (RN) staffing, low nursing support staffing, and high patient turnover.

Association of inpatient mortality

The association of nursing staffing with patient outcomes has primarily study by comparing high to low staff hospitals; so raising concern other factors may account for observe differences. They examine the association of inpatient mortality with patients’ cumulative exposure to shifts with low register nurse (RN) staffing; which low nursing support staffing and high patient turnover.

Cumulative counts of exposure to shifts with low staffing and high patient turnover were use as time-varying covariates in survival analysis of data from a three-campus US academic medical centre for 2007–2012. Staffing below 75% of annual median unit staffing for each staff category and shift type was characterize as low. High patient turnover per day was define as admissions; discharges and transfers 1 SD above unit annual daily averages.

The analysis include data from a three-campus U.S. academic medical center (2007 to 2012). Low staffing was define as staffing below 75 percent of annual median unit staffing for each staff category and shift type; while high patient turnover per day was define as admissions, discharges, and transfers one standard deviation above unit annual daily averages.

Nursing support staffing

The researchers find that the hazard ratio (HR) of inpatient mortality was 1.027 (95% confidence interval [CI], 1.002 to 1.053; P = 0.035) for exposure to shifts with low RN staffing only, 1.030 for shifts with low nursing support only, and 1.025 (95% CI, 1.008 to 1.043; P = 0.004) for shifts with both low RN and nursing support staffing.

For cumulative exposure during the second to fifth days of an admission; so the HR of inpatient mortality was 1.048 for exposure to shifts with low RN staffing only; so 1.032 for shifts with low nursing support only; also 1.136 for shifts with both low RN and nursing support staffing. There was no association between high patient turnover and mortality.

“The results should encourage hospital leadership to assure both adequate RN and nursing support staffing,” the authors write. Low RN and nursing support staffing were associated with increased mortality. The results should encourage hospital leadership to assure both adequate RN and nursing support staffing.