Aim: The aim of the study was to assess the influence of the number of hours of daily nursing care for NHPPD in medical departments on missed care and the correlation between NHPPD and in-hospital mortality. Background: Patient mortality can be a consequence of missed care as it correlates with the nurse-patient ratio. One of the methods to measure missed care is the Nursing Hours per Patient Day rating. Methods: The study sample included 44,809 patients including 971 deaths in 8 wards. The influence of nursing hours, nursing education, and the percentage of patients' classification on in-hospital mortality were evaluated with backward stepwise linear regression. Results: One hour added to the average NHPPD in medical departments was related to a decrease in mortality rate by 6.8 per 1,000 patient days and a lower chance for the emergence of unplanned death by 36%. Conclusions: The number of NHPPD and the percentage of professional nurses are factors influencing missed care and in-hospital mortality. Implications for Nursing Management: The severe consequences of missed care, that is mortality, and the correlation between in-hospital mortality, nursing education and nursing-patient ratio, which are indicators of care quality, are arguments for maintaining adequate staffing levels to avoid missed care. How to cite this article: Wieczorek-Wojcik B, Gaworska-Krzemińska A, Owczarek AJ, Kilańska D. In-hospital mortality as the side effect of missed care.

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The preparation, agreement and dissemination of the ENS4Care guidelines will enable European Union leaders to diagnose the organizational changes needed and prescribe the development of new skills and roles in the workforce to meet the challenge of eHealth. Nurses and social care workers, with the right knowledge and skills will add considerable value and form an important link between technological innovation, health promotion and disease prevention.

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Discussing the barriers to the implementation of the Classification can improve understanding of it and its use. At a policy level, decision makers need to understand that use Classification in eHealth services and tools it is necessary to achieve interoperability.