Higher staffing levels linked to reduced risk of inpatient death

A study led by King’s College London and the University of Southampton has shown that a higher registered nurse to patient ratio is linked to a reduced risk of inpatient death.
The study of staffing levels in NHS hospitals found that in trusts where registered nurses had six or fewer patients to care for, the death rate for patients with medical conditions was 20 per cent lower than in those where they had more than 10. Hospitals with more doctors per bed also had lower death rates but hospitals with more unregistered nursing support workers may have had higher death rates.
The study, by researchers from King’s College London, the University of Southampton, Karolinska Institutet, Stockholm and the New York School of Medicine, analysed two measures over two years (2009-11): the number of beds per registered nurse, doctor, and healthcare support worker in 137 acute care trusts; and the number of patients per ward nurse, drawn from a survey of just under 3000 registered nurses in a nationally representative sample of 31 of these trusts (46 hospitals and 401 wards).
They also calculated the predicted number of deaths for medical and surgical inpatients, taking account of influential factors, such as age, other underlying conditions, and number of emergency admissions during the previous 12 months.
Among patients admitted to medical, wards, higher death rates were associated with higher numbers of occupied beds for each registered nurse and for each doctor employed by the trust. By contrast, higher numbers of healthcare support workers were associated with higher rates of inpatient death.
When all staff groups were included in the statistical analysis of all 137 trusts, the associations remained significant only for doctors and healthcare support workers.
But analysis focussing on nurses actually working on wards of the subsidiary group of 31 trusts showed that the death rate was 20 per cent lower in those where each registered nurse cared for an average of six or fewer medical inpatients than in trusts were each registered nurse cared for 10 or more. These associations remained significant after further statistical analysis.
The results on surgical wards were similar, with higher registered nurse to patient ratios associated with a 17 per cent lower inpatient death rate.
The registered nurse headcount varied by as much as a factor of four between those at the top and bottom of the staffing scale. Even after taking account of all nursing staff, this variation only dropped to a threefold difference between those with the highest and lowest nurse headcounts.

Kings College London http://tinyurl.com/hujb9hc