Effects of Hospital Nurse Staffing on in-hospital Mortality, Pneumonia, Sepsis, and Urinary Tract Infection in Surgical Patients

Abstract

Purpose: This study was done to examine relationships between nurse staffing level and postsurgical patient outcomes using inpatient database from the National Health Insurance. Methods: Records of 111,491 patients who received one of 12 types of surgery between January and December, 2009 were identified and analyzed in this study. Nurse staffing level was measured using adjusted nurse staffing grades from 0 to 7. Patient outcomes were defined as in-hospital mortality, or pneumonia, sepsis, or urinary tract infection after surgery. Logistic regression analyses estimated by Generalized Estimation Model, were used to analyze the association between nurse staffing level and patient outcomes. Results: An inverse relationship was found between nurse staffing and patient mortality. Compared with patients who were cared for in hospitals with the highest nurse staffing (Grades 0-1), increases in the odds of dying were found in those with Grades 6-7 [OR (odds ratio)= 2.99, 95% CI (confidence interval)= 1.94-4.60], those with Grades 4-5 (OR= 1.78, 95% CI= 1.24-2.57) and those with Grades 2-3 (OR= 1.57, 95% CI= 1.25-1.98). Lower nurse staffing level was also associated with higher number of cases in pneumonia and sepsis. Conclusion: Policies for providing adequate nurse staffing is required to enhance quality of care and lead to better perioperative patient outcomes.

The association between nurse staffing levels and paediatric nursing-sensitive outcomes in tertiary hospitals

“…Severity may need to be adjusted using paediatric pressure ulcer risk‐assessment tools such as the Braden Q Scale and Glamorgan Scale, which include more sensitive risk factors such as incontinence, mobility, nutritional status, tissue oxygenation, and perfusion (Baharestani & Ratliff, ). Further, in previous studies in the adult population, nurse staffing levels and lower rates of failure to rescue have been associated (Kim, Cho, June, Shin, & Kim, ), which differs from the results of this study. Failure to rescue may need to be adjusted using paediatric mortality risk assessment tools, such as the Pediatric Risk of Mortality III (PRISM III) score, and the Sequential Organ Failure Assessment (SOFA) score (Kim et al., ; ; Pollack et al., ; ).…”

Effect of nurse staffing variation and hospital resource utilization

“…In addition to that of LOS and medical expenses, an inverse relationship between nurse staffing and nurse sensitive outcomes (e.g. urinary tract infections, pneumonia, and wound infections) has been amply demonstrated (Cho et al ., ; Lankshear et al ., ; Kane et al ., ; Cho & Yun, ; Kim et al ., ). The occurrence of these adverse events could be associated with a significantly prolonged LOS and could subsequently increase healthcare expenses.…”

“…Research evidence concerning the relationship between nurse staffing and patient outcomes has increased. Most studies report an association of increased registered nurse (RN) staffing levels with lower rates of hospital mortality and adverse patient events in Korea, as well as in other countries (Lankshear et al ., ; Kane et al ., ; Cho & Yun, ; Kim et al ., ). However, a systematic review found a mixed impact of nurse staffing on hospital costs or LOS (Thungjaroenkul et al ., ).…”

“…Kim et al . () reported that lower nurse staffing levels were associated with higher numbers of cases of pneumonia, sepsis, urinary tract infections, and in‐hospital mortality in surgical patients. Inadequate staffing contributed to difficult nurse work environments, and resulted in poor job performance (Unruh, ; Nantsupawat et al ., ).…”

Association between the bed-to-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery: a cross-sectional analysis using Korean administrative data

“…The 12 types of surgery analyzed in this study were determined using Korean Diagnosis-Related Group (KDRG) categories with relatively high death rates according to previous studies (craniotomy, cardiovascular surgery, digestive system surgery, and hepatobiliary system surgery). Their KDRG categories were as follows: major craniotomy except for trauma (B011-B019), other craniotomy except for trauma (B021-B022), craniotomy for trauma (B030), cardiac valve procedure with cardiac catheter (F021-F023), cardiac valve procedure without cardiac catheter (F031-F033), coronary bypass with/without cardiac catheter (F041-F044), major reconstructive vascular procedure (F061-F064), amputation for circulatory system disorders (F120), esophageal procedure (G011-G013), major small and large bowel procedure (G031-G033), stomach and duodenal procedure (G041-G046), and pancreas, liver and shunt procedure (H011-H016) [1][2][3]17]. The exclusion criteria encompassed patients who had been transferred to other hospitals during their hospital stay after surgery, inpatients in special treatment rooms (aseptic rooms, isolated rooms, rooms with lead shielding, etc.…”