Context-Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention.Objectives-To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care.Design and setting-Cross-sectional analysis combining nurse survey data with discharge abstracts.Participants-Nurses (N = 3984) and general, orthopaedic, and vascular surgery patients (N = 118 752) in 30 English acute trusts.Results-Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12-49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals.Conclusions-Nurse staffing levels in NHS hospitals appear to have the same impact on patient outcomes and factors influencing nurse retention as have been found in the USA. Outcomes of variation in hospital nurse staffing in English hospitalsThe impact of nurse staffing on patient outcomes has been controversial in the US and as contentious in the UK. A 2001 Audit Commission report on ward staffing in National Health Service (NHS) hospitals noted considerable variation across trusts in expenditures on nurse staffing but was not able to determine whether those differences were associated with variation in patient outcomes (Audit Commission, 2001). The Commission concluded, "Unless and until trusts that spend more [on staffing] can demonstrate a clear link with the quality of care that is delivered, movement towards a more even allocation of resources seems reasonable both for patients and staff." (1, p. 15). The Healthcare Commission released a report in June 2005 suggesting that patients were more satisfied in hospitals with more qualified nurses but emphasized again the lack of evidence linking staffing to patient outcomes and the need for research to guide decision-making in this area (Healthcare Commission, 2005).The Audit Commission's report coincided with the publication of the first results from the five-country International Hospital Outcomes Study. The International Hospital Outcomes Study, involving seven interdisciplinary research teams in five countries (US, Canada, England, Scotland and Germany), examined the extent to which the relationships between nurse staffing, the quality of the nurse work environment, and patient and nurse outcomes are similar across countries with well-resourced health care systems (Aiken et al., 2002a, b). It was seen that...

Objective To assess the validity of clinical information held on a regional maternity database, the St Mary's Maternity Information System (SMMIS). Design A retrospective review of 892 maternity case notes and matched SMMIS records, by a midwife trained in clinical coding techniques. Setting Three maternity units in the North West Thames Region. Main outcome measures Percentage agreement for 17 directly recorded SMMIS data items and equivalent data abstracted from the notes. Frequencies of diagnosis codes abstracted from case notes, as compared with those generated by SMMIS on the basis of directly recorded data. Results A generally high level of agreement was observed between the abstracts of the notes and the SMMIS records. Of the 17 data items examined, 10 showed 95% agreement or better, and all but two exceeded 80% agreement. Little difference was found between the levels of agreement observed at the three sites. A greater number and range of diagnosis codes were abstracted from the notes than were generated by SMMIS. Conclusions The directly recorded clinical data held on the SMMIS regional database is largely accurate and consistently recorded across a variety of units. The database can therefore be considered a valuable resource for the comparative audit of maternity practice. The SMMIS technique for deriving, on a semi‐automatic basis, diagnosis codes from the directly recorded fields, appears to work moderately well. We suggest that the direct method of data collection used in SMMIS could provide a model for other specialties in the National Health Service.

There have been several recent calls for better data on NHS outputs and outcomes in England, which will require new data collection with long lead times. In this, the first of two articles, the authors show what can be done now with existing routine data across many sectors and raise issues about assumptions and technical aspects for discussion.A recent BMJ editorial on whether the NHS was improving after recent government investments concluded that we did not have the data to answer the question reliably.

The overall early mortality rate after TURP for benign prostatic hyperplasia across the Region compares well with other reported large series. The significant variation in morbidity rates found in this study suggests that careful attention needs to be paid by Urologists, Purchasers and Providers to morbidity rates after prostatectomy.