Longitudinal Analyses of Nurse Staffing and Patient Outcomes

Seago, Jean Ann; Williamson, Ann; Atwood, Christina

doi:10.1097/00005110-200601000-00005

Cited by 96 publications

(72 citation statements)

References 11 publications

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“…Studies found no association with mortality (Unruh et al, 2007), failure to rescue (Park et al, 2012), length of stay (Unruh et al, 2007), venous thromboembolism (Ibe et al, 2008), or missed care . However, higher assistant staffing was associated with higher rates of falls (Hart andDavis, 2011, Lake et al, 2010), pressure ulcers (Seago et al, 2006), readmission rates (Weiss et al, 2011), medication errors (Seago et al, 2006), use of physical restraints M a n u s c r i p t…”

Section: O U T C O M E S a S S O C I A T E D W I T H N U R S I N G A mentioning

confidence: 99%

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Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Griffiths

Ball

Drennan

et al. 2016

International Journal of Nursing Studies

228

216

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What is already known? A number of high quality reviews establish an association between lower registered nurse staffing levels, increased mortality rates and other adverse outcomes  Careful analysis of this evidence suggests that it is consistent with a causal relationship  Translation of this evidence into practice is disputedWhat this paper adds  This paper summarises and extends a recent systematic review on nurse staffing and outcomes undertaken for England's National Institute for Health and Care Excellence  Methodological limitations mean that existing studies may not give unbiased estimates of the benefits from increased nurse staffing, with over and underestimation of benefit both possible, which makes it difficult to directly translate evidence into guidance for practice. We identify avenues for progressing this important research so that future studies might be better able to provide the evidence needed to inform policy and practice, and provide a checklist to aid future study development AbstractA large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as "compelling" and "overwhelming", there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence (NICE), which concluded there is insufficient good quality evidence available to fully inform practice.In this paper we explore this apparent contradiction. After summarising the evidence review that informed the NICE guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey.Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing, it may not provide operational solutions. We conclude by posing a ser...

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Section: O U T C O M E S a S S O C I A T E D W I T H N U R S I N G A mentioning

confidence: 99%

“…Page 11 (Hart and Davis, 2011) and lower levels of patient satisfaction (Seago et al, 2006), although one weak study found that higher HCA staffing levels were associated with lower rates of pressure ulcers (Ibe et al, 2008). …”

Section: March 2016mentioning

confidence: 99%

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Griffiths

Ball

Drennan

et al. 2016

International Journal of Nursing Studies

228

216

View full text Add to dashboard Cite

show abstract

“…Studies of nurseto-patient ratios find that adequate staffing is associated with fewer adverse events (2,102). In contrast, less adequate staffing levels (indicated by workload, overtime, or increased nonregistered nurse hours of care) resulted in unexpected deaths (28) and medication errors (132).…”

Section: Internal Motivatorsmentioning

confidence: 99%

Reducing Hospital Errors: Interventions that Build Safety Culture

Singer¹,

Vogus

2013

Annu. Rev. Public Health

153

145

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Hospital errors are a seemingly intractable problem and continuing threat to public health. Errors resist intervention because too often the interventions deployed fail to address the fundamental source of errors: weak organizational safety culture. This review applies and extends a theoretical model of safety culture that suggests it is a function of interrelated processes of enabling, enacting, and elaborating that can reduce hospital errors over time. In this model, enabling activities help shape perceptions of safety climate, which promotes enactment of safety culture. We then classify a broad array of interventions as enabling, enacting, or elaborating a culture of safety. Our analysis, which is intended to guide future attempts to both study and more effectively create and sustain a safety culture, emphasizes that isolated interventions are unlikely to reduce the underlying causes of hospital errors. Instead, reducing errors requires systemic interventions that address the interrelated processes of safety culture in a balanced manner.

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“…Antitumor drug therapy may require nursing services that are not properly evaluated by the NND. A number of studies have suggested that adequate staffing is associated with improved patient outcomes [13][14][15]. Moreover, high patient-to-nurse ratios more likely lead to low burnout and dissatisfaction [15,16].…”

Section: X>＄10732 18mentioning

confidence: 99%

“…A number of studies have suggested that adequate staffing is associated with improved patient outcomes [13][14][15]. Moreover, high patient-to-nurse ratios more likely lead to low burnout and dissatisfaction [15,16]. Future studies are needed to clarify the number of nurses required for antitumor drug therapy under the classification of NND.…”

Section: X>＄10732 18mentioning

confidence: 99%

Economic Estimation of Nursing Services under the Diagnostic Procedure Combination/Per-Diem Payment System

Akiyama¹,

Akiyama

Hayashida³

et al. 2013

J Nurs Care

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Aim: The purpose of this study was to determine whether the amount of nursing services estimated under the classification of Nursing Need Degree is adequately evaluated for each Diagnostic Procedure Combination (DPC) reimbursement.Methods: A longitudinal cohort study design was employed to examine all 28,757 hospitalizations, except for those due to tuberculosis, in Hospital A in Japan between July 2008 and March 2010. We excluded the following patients from analysis: patients who were not applicable to the DPC system; patients who were hospitalized beyond the specified DPC period; and patients who were applicable to the specified hospital fee. We collected data from the administration system of medical business and Nursing Need Degree (NND). We calculated the mean of the hospital fee portion (i.e., fees for room and nursing services) per total number of nurses required and created a list of per-nurseday unit price for each DPC group, only if the number of patients included in the identical DPC group exceeded 20. We described about the number of assigned DPC codes, in such a way as to distribution of percent difference from the mean of hospital fee portion/total necessary number of nurses for each DPC group. In addition, we focused on the difference from the mean by 30%.Results: A significant correlation was found between the hospital fee portion and total number of nurses required under the DPC system. However, the distribution of percent differences among the mean of the hospital fee portion per total number of nurses required revealed that 39 of 179 DPC code groups were either underestimated or overestimated. The underestimated group included a number of obstetrics-and gynecology-related diseases, whereas the overestimated group included many non-surgical, cancer-related diseases. Conclusions:Our results significantly contribute to the identification of DPC codes that do not adequately reflect nursing services required under the present DPC payment system.

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Longitudinal Analyses of Nurse Staffing and Patient Outcomes

Abstract: The overall conclusion is that it will likely be necessary to vary staffing hours and staffing mix depending on which positive patient outcome or outcomes you wish to achieve.

Cited by 96 publications

References 11 publications

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Reducing Hospital Errors: Interventions that Build Safety Culture

Economic Estimation of Nursing Services under the Diagnostic Procedure Combination/Per-Diem Payment System

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