Nurse staffing, nursing assistants and hospital mortality: Retrospective longitudinal cohort study
Authors: Griffiths, P., Maruotti, A., Recio Saucedo, A., Redfern, O.C., Ball, J.E., Briggs, J., Dall'Ora, C., Schmidt, P.E. and Smith, G.B.
Journal: BMJ Quality and Safety
Volume: 28
Issue: 8
Pages: 609-617
ISSN: 2044-5415
DOI: 10.1136/bmjqs-2018-008043
Abstract:Objective To determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality. Design This is a retrospective longitudinal observational study using routinely collected data. We used multilevel/hierarchical mixed-effects regression models to explore the association between patient outcomes and daily variation in RN and nursing assistant staffing, measured as hours per patient per day relative to ward mean. Analyses were controlled for ward and patient risk. Participants 138 133 adult patients spending >1 days on general wards between 1 April 2012 and 31 March 2015. Outcomes In-hospital deaths. Results Hospital mortality was 4.1%. The hazard of death was increased by 3% for every day a patient experienced RN staffing below ward mean (adjusted HR (aHR) 1.03, 95% CI 1.01 to 1.05). Relative to ward mean, each additional hour of RN care available over the first 5 days of a patient's stay was associated with 3% reduction in the hazard of death (aHR 0.97, 95% CI 0.94 to 1.0). Days where admissions per RN exceeded 125% of the ward mean were associated with an increased hazard of death (aHR 1.05, 95% CI 1.01 1.09). Although low nursing assistant staffing was associated with increases in mortality, high nursing assistant staffing was also associated with increased mortality. Conclusion Lower RN staffing and higher levels of admissions per RN are associated with increased risk of death during an admission to hospital. These findings highlight the possible consequences of reduced nurse staffing and do not give support to policies that encourage the use of nursing assistants to compensate for shortages of RNs.
https://eprints.bournemouth.ac.uk/32054/
Source: Scopus
Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study.
Authors: Griffiths, P., Maruotti, A., Recio Saucedo, A., Redfern, O.C., Ball, J.E., Briggs, J., Dall'Ora, C., Schmidt, P.E., Smith, G.B. and Missed Care Study Group
Journal: BMJ Qual Saf
Volume: 28
Issue: 8
Pages: 609-617
eISSN: 2044-5423
DOI: 10.1136/bmjqs-2018-008043
Abstract:OBJECTIVE: To determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality. DESIGN: This is a retrospective longitudinal observational study using routinely collected data. We used multilevel/hierarchical mixed-effects regression models to explore the association between patient outcomes and daily variation in RN and nursing assistant staffing, measured as hours per patient per day relative to ward mean. Analyses were controlled for ward and patient risk. PARTICIPANTS: 138 133 adult patients spending >1 days on general wards between 1 April 2012 and 31 March 2015. OUTCOMES: In-hospital deaths. RESULTS: Hospital mortality was 4.1%. The hazard of death was increased by 3% for every day a patient experienced RN staffing below ward mean (adjusted HR (aHR) 1.03, 95% CI 1.01 to 1.05). Relative to ward mean, each additional hour of RN care available over the first 5 days of a patient's stay was associated with 3% reduction in the hazard of death (aHR 0.97, 95% CI 0.94 to 1.0). Days where admissions per RN exceeded 125% of the ward mean were associated with an increased hazard of death (aHR 1.05, 95% CI 1.01 1.09). Although low nursing assistant staffing was associated with increases in mortality, high nursing assistant staffing was also associated with increased mortality. CONCLUSION: Lower RN staffing and higher levels of admissions per RN are associated with increased risk of death during an admission to hospital. These findings highlight the possible consequences of reduced nurse staffing and do not give support to policies that encourage the use of nursing assistants to compensate for shortages of RNs.
https://eprints.bournemouth.ac.uk/32054/
Source: PubMed
Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study
Authors: Griffiths, P., Maruotti, A., Saucedo, A.R., Redfern, O.C., Ball, J.E., Briggs, J., Dall'Ora, C., Schmidt, P.E. and Smith, G.B.
Journal: BMJ QUALITY & SAFETY
Volume: 28
Issue: 8
Pages: 609-617
eISSN: 2044-5423
ISSN: 2044-5415
DOI: 10.1136/bmjqs-2018-008043
https://eprints.bournemouth.ac.uk/32054/
Source: Web of Science (Lite)
Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study.
Authors: Griffiths, P., Maruotti, A., Recio Saucedo, A., Redfern, O.C., Ball, J.E., Briggs, J., Dall'Ora, C., Schmidt, P.E., Smith, G.B. and Missed Care Study Group
Journal: BMJ quality & safety
Volume: 28
Issue: 8
Pages: 609-617
eISSN: 2044-5423
ISSN: 2044-5415
DOI: 10.1136/bmjqs-2018-008043
Abstract:Objective
To determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality.Design
This is a retrospective longitudinal observational study using routinely collected data. We used multilevel/hierarchical mixed-effects regression models to explore the association between patient outcomes and daily variation in RN and nursing assistant staffing, measured as hours per patient per day relative to ward mean. Analyses were controlled for ward and patient risk.Participants
138 133 adult patients spending >1 days on general wards between 1 April 2012 and 31 March 2015.Outcomes
In-hospital deaths.Results
Hospital mortality was 4.1%. The hazard of death was increased by 3% for every day a patient experienced RN staffing below ward mean (adjusted HR (aHR) 1.03, 95% CI 1.01 to 1.05). Relative to ward mean, each additional hour of RN care available over the first 5 days of a patient's stay was associated with 3% reduction in the hazard of death (aHR 0.97, 95% CI 0.94 to 1.0). Days where admissions per RN exceeded 125% of the ward mean were associated with an increased hazard of death (aHR 1.05, 95% CI 1.01 1.09). Although low nursing assistant staffing was associated with increases in mortality, high nursing assistant staffing was also associated with increased mortality.Conclusion
Lower RN staffing and higher levels of admissions per RN are associated with increased risk of death during an admission to hospital. These findings highlight the possible consequences of reduced nurse staffing and do not give support to policies that encourage the use of nursing assistants to compensate for shortages of RNs.https://eprints.bournemouth.ac.uk/32054/
Source: Europe PubMed Central
Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study.
Authors: Griffiths, P., Maruotti, A., Recio Saucedo, A., Redfern, O.C., Ball, J.E., Briggs, J., Dall'Ora, C., Schmidt, P.E. and Smith, G.B.
Journal: BMJ Quality and Safety
Volume: 28
Pages: 609-617
ISSN: 2044-5415
Abstract:OBJECTIVE: To determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality. DESIGN: This is a retrospective longitudinal observational study using routinely collected data. We used multilevel/hierarchical mixed-effects regression models to explore the association between patient outcomes and daily variation in RN and nursing assistant staffing, measured as hours per patient per day relative to ward mean. Analyses were controlled for ward and patient risk. PARTICIPANTS: 138 133 adult patients spending >1 days on general wards between 1 April 2012 and 31 March 2015. OUTCOMES: In-hospital deaths. RESULTS: Hospital mortality was 4.1%. The hazard of death was increased by 3% for every day a patient experienced RN staffing below ward mean (adjusted HR (aHR) 1.03, 95% CI 1.01 to 1.05). Relative to ward mean, each additional hour of RN care available over the first 5 days of a patient's stay was associated with 3% reduction in the hazard of death (aHR 0.97, 95% CI 0.94 to 1.0). Days where admissions per RN exceeded 125% of the ward mean were associated with an increased hazard of death (aHR 1.05, 95% CI 1.01 1.09). Although low nursing assistant staffing was associated with increases in mortality, high nursing assistant staffing was also associated with increased mortality. CONCLUSION: Lower RN staffing and higher levels of admissions per RN are associated with increased risk of death during an admission to hospital. These findings highlight the possible consequences of reduced nurse staffing and do not give support to policies that encourage the use of nursing assistants to compensate for shortages of RNs.
https://eprints.bournemouth.ac.uk/32054/
Source: BURO EPrints