The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study
Abstract Background Growing evidence indicates that improved nurse staffing in acute hospitals is associated with lower hospital mortality. Current research is limited to studies using hospital level data or without proper adjustment for confounders which makes the translation to practice difficult....
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| Format: | Article |
| Language: | English |
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BMC
2019-11-01
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| Series: | BMC Health Services Research |
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| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4688-7 |
| _version_ | 1818405580962791424 |
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| author | Filip Haegdorens Peter Van Bogaert Koen De Meester Koenraad G. Monsieurs |
| author_facet | Filip Haegdorens Peter Van Bogaert Koen De Meester Koenraad G. Monsieurs |
| author_sort | Filip Haegdorens |
| collection | DOAJ |
| description | Abstract Background Growing evidence indicates that improved nurse staffing in acute hospitals is associated with lower hospital mortality. Current research is limited to studies using hospital level data or without proper adjustment for confounders which makes the translation to practice difficult. Method In this observational study we analysed retrospectively the control group of a stepped wedge randomised controlled trial concerning 14 medical and 14 surgical wards in seven Belgian hospitals. All patients admitted to these wards during the control period were included in this study. Pregnant patients or children below 17 years of age were excluded. In all patients, we collected age, crude ward mortality, unexpected death, cardiac arrest with Cardiopulmonary Resuscitation (CPR), and unplanned admission to the Intensive Care Unit (ICU). A composite mortality measure was constructed including unexpected death and death up to 72 h after cardiac arrest with CPR or unplanned ICU admission. Every 4 months we obtained, from 30 consecutive patient admissions across all wards, the Charlson comorbidity index. The amount of nursing hours per patient days (NHPPD) were calculated every day for 15 days, once every 4 months. Data were aggregated to the ward level resulting in 68 estimates across wards and time. Linear mixed models were used since they are most appropriate in case of clustered and repeated measures data. Results The unexpected death rate was 1.80 per 1000 patients. Up to 0.76 per 1000 patients died after CPR and 0.62 per 1000 patients died after unplanned admission to the ICU. The mean composite mortality was 3.18 per 1000 patients. The mean NHPPD and proportion of nurse Bachelor hours were respectively 2.48 and 0.59. We found a negative association between the nursing hours per patient day and the composite mortality rate adjusted for possible confounders (B = − 2.771, p = 0.002). The proportion of nurse Bachelor hours was negatively correlated with the composite mortality rate in the same analysis (B = − 8.845, p = 0.023). Using the regression equation, we calculated theoretically optimal NHPPDs. Conclusions This study confirms the association between higher nurse staffing levels and lower patient mortality controlled for relevant confounders. |
| first_indexed | 2024-12-14T08:58:19Z |
| format | Article |
| id | doaj.art-3bde8d3ae5474580a20bf1abf3a61ee6 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-14T08:58:19Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-3bde8d3ae5474580a20bf1abf3a61ee62022-12-21T23:08:52ZengBMCBMC Health Services Research1472-69632019-11-011911910.1186/s12913-019-4688-7The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre studyFilip Haegdorens0Peter Van Bogaert1Koen De Meester2Koenraad G. Monsieurs3Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of AntwerpCentre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of AntwerpCentre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of AntwerpDepartment of emergency medicine, Antwerp University Hospital, University of AntwerpAbstract Background Growing evidence indicates that improved nurse staffing in acute hospitals is associated with lower hospital mortality. Current research is limited to studies using hospital level data or without proper adjustment for confounders which makes the translation to practice difficult. Method In this observational study we analysed retrospectively the control group of a stepped wedge randomised controlled trial concerning 14 medical and 14 surgical wards in seven Belgian hospitals. All patients admitted to these wards during the control period were included in this study. Pregnant patients or children below 17 years of age were excluded. In all patients, we collected age, crude ward mortality, unexpected death, cardiac arrest with Cardiopulmonary Resuscitation (CPR), and unplanned admission to the Intensive Care Unit (ICU). A composite mortality measure was constructed including unexpected death and death up to 72 h after cardiac arrest with CPR or unplanned ICU admission. Every 4 months we obtained, from 30 consecutive patient admissions across all wards, the Charlson comorbidity index. The amount of nursing hours per patient days (NHPPD) were calculated every day for 15 days, once every 4 months. Data were aggregated to the ward level resulting in 68 estimates across wards and time. Linear mixed models were used since they are most appropriate in case of clustered and repeated measures data. Results The unexpected death rate was 1.80 per 1000 patients. Up to 0.76 per 1000 patients died after CPR and 0.62 per 1000 patients died after unplanned admission to the ICU. The mean composite mortality was 3.18 per 1000 patients. The mean NHPPD and proportion of nurse Bachelor hours were respectively 2.48 and 0.59. We found a negative association between the nursing hours per patient day and the composite mortality rate adjusted for possible confounders (B = − 2.771, p = 0.002). The proportion of nurse Bachelor hours was negatively correlated with the composite mortality rate in the same analysis (B = − 8.845, p = 0.023). Using the regression equation, we calculated theoretically optimal NHPPDs. Conclusions This study confirms the association between higher nurse staffing levels and lower patient mortality controlled for relevant confounders.http://link.springer.com/article/10.1186/s12913-019-4688-7MortalityNurse staffingNurse educationOutcomes |
| spellingShingle | Filip Haegdorens Peter Van Bogaert Koen De Meester Koenraad G. Monsieurs The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study BMC Health Services Research Mortality Nurse staffing Nurse education Outcomes |
| title | The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study |
| title_full | The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study |
| title_fullStr | The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study |
| title_full_unstemmed | The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study |
| title_short | The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study |
| title_sort | impact of nurse staffing levels and nurse s education on patient mortality in medical and surgical wards an observational multicentre study |
| topic | Mortality Nurse staffing Nurse education Outcomes |
| url | http://link.springer.com/article/10.1186/s12913-019-4688-7 |
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