Adequacy of Dialysis Clinic Staffing and Quality of Care: A Review of Evidence and Areas of Needed Research

Wolfe, William A.

doi:10.1053/j.ajkd.2011.03.027

Cited by 39 publications

(43 citation statements)

References 64 publications

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“…Structural staffing issues, specifically inadequate nurse staffing in acute care hospitals, have been linked to heightened risk of infection [40], mortality [41], and other adverse consequences [42-45]. Adequacy of dialysis clinic staffing and quality of care are linked [46], although what constitutes “adequate” staffing at dialysis facilities has not yet been defined, particularly with respect to ameliorating hospitalization risk [47]. Indeed, there is urgent need for further study of the optimal dialysis patient-to-staffing ratios given recent controversy with respect to legislation regarding mandated dialysis staffing ratios in ambulatory facilities.…”

Section: Discussionmentioning

confidence: 99%

Association of US Dialysis Facility Staffing with Profiling of Hospital-Wide 30-Day Unplanned Readmission

Chen¹,

Rhee²,

Şentürk³

et al. 2019

Kidney Dis

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Background: Unplanned hospital readmissions are a major source of morbidity among dialysis patients, in whom the risk of hospital readmission is exceptionally high. The contribution of dialysis facility staffing to hospital readmission has been largely overlooked. Methods: Using annual data of dialysis patients from the United States Renal Data System from 2010 to 2013, we assessed dialysis facilities with a significantly worse (SW) and facilities with a nonsignificant (NS) standardized readmission ratio (SRR). SRR estimates were risk adjusted for patient factors, past year comorbidities, and index hospitalization characteristics. Facility staffing variables were compared between 2 exposure groups: facilities with SW and NS SRRs. Four measures of staffing, including patient-to-staffing ratio, were compared between SW and matched NS facilities. Results: About 136,000–148,000 dialysis patients with 269,000–319,000 index hospital discharges were used to identify facilities with SW and facilities with NS SRR annually. Approximately 3–4% of facilities were identified as having SW SRR among > 5,000 facilities annually. The percent of nurses-to-total staff was significantly lower in 2010 for SW facilities than in matched NS facilities (42.5 vs. 45.6%, p = 0.012), but this disparity was attenuated by 2013 (44.8 vs. 44.7%, p = 0.949). There was a higher patient-to-nurse ratio for SW facilities than for NS facilities (mean 16.4 vs. 15.2, p = 0.038) in 2010 as well, and the disparity was reduced by 2013. The trends were similar for patient-to-total staff and patient-to-registered nurse, but not statistically significant. Conclusions: This study found that dialysis facilities with SW 30-day readmission rates had lower proportions of nurses-to-total staff and higher patient-to-nurse ratios, but this disparity improved in recent years. Additional research is warranted focusing on how evidence-based staffing at dialysis facilities can contribute to reduction of hospital readmission, and this knowledge is needed to inform clinical practice guidelines and policy decisions regarding optimal dialysis patient staffing.

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Section: Discussionmentioning

confidence: 99%

Association of US Dialysis Facility Staffing with Profiling of Hospital-Wide 30-Day Unplanned Readmission

Chen¹,

Rhee²,

Şentürk³

et al. 2019

Kidney Dis

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“…15 Furthermore, replacing licensed nurses with patient care technicians may jeopardize long-term patient outcomes. 9 Even when the unlicensed technicians are functioning under the direct supervision of a licensed nurse, having fewer licensed nurses per patient increases the demands on the licensed nurse. 16 …”

Section: Discussionmentioning

confidence: 99%

“…20 In essence, the regional differences could be driven by the supply of Registered Nurses or variations in state nurse practice regulations; however, most states do not specify any regulations for nurse-staffing mix in hemodialysis facilities, and of the five that do (MA, CT, NJ, TX, GA), none of the designated ratios differentiate between RNs and LPNs. 9 …”

Section: Discussionmentioning

confidence: 99%

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Patient Care Staffing Levels and Facility Characteristics in US Hemodialysis Facilities

Yoder

Xin

Norris

et al. 2013

American Journal of Kidney Diseases

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Background Higher numbers of registered nurses per patient have been associated with improved patient outcomes in acute care facilities. Variation and associations of patient-care staffing levels and hemodialysis facility characteristics have not been previously examined. Study Design Cross-sectional study using Poisson regression to examine associations betwee patient-care staffing levels and hemodialysis facility characteristics. Setting & Participants 4,800 U.S. hemodialysis facilities in the 2009 CMS ESRD Annual Facility Survey (CMS-2744), USRDS. Predictors Facility characteristics, including profit status, freestanding status, chain affiliatio and geographic region, adjusted for facility size, capacity, functional type, and urbanicity. Outcomes Patient care staffing levels, including ratios of Registered Nurses (RN), Licensed Practical Nurses (LPN), Patient Care Technicians (PCT), composite staff (RN+LPN+PCT), Social Workers, and Dietitians to in-center hemodialysis patients. Results After adjusting for background facility characteristics, the ratios of RNs and LPNs to patients were 35% (p<0.001) and 42% (p<0.001) lower, but the PCT-to-patient ratio was 16% (p<0.001) higher in for-profit facilities than those in nonprofit facilities (Rate ratio, 0.65, 95%CI, 0.63–0.68; 0.58, 0.51–0.65; 1.16, 1.12–1.19; respectively). Regionally, compared to the Northeast, the adjusted RN-to-patient ratio was 14% (p< 0.001) lower in the Midwest, 25% (p< 0.001) lower in the South, and 18% (p< 0.001) lower in the West. Even after additional adjustments, the large for-profit chains had significantly lower RN and LPN ratios than the largest nonprofit chain, but a significantly higher PCT-to-patient ratio. The overall composite staffing levels were also lower in for-profit and chain-affiliated facilities. The patterns hold when the hospital-based units were excluded. Limitations Nursing hours were not available. Conclusions The significant variation in patient-care staffing levels and its associations with facility characteristics warrants inclusion in future large-scale hemodialysis outcomes studies. ESRD networks and hemodialysis facilities should attend to quality assurance and performance improvement initiatives that maximize licensed nurse-staffing levels in hemodialysis facilities.

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“…In USA, a total of 4 hundred thousand adverse events led to 2.1 hundred thousand deaths annually (James, 2013). Shortage of nursing led to increase the pressure in healthcare service (Cramer, Jones, & Hertzog, 2011;Hinno, Partanen, & Vehviläinen-Julkunen, 2011;Mu'taman Jarrar, Abdul Rahman, & Shamsudin, 2015;Knight, 2015;McHugh et al, 2016;Watson et al, 2016;Wolfe, 2011). Nurses working longer shifts (Stimpfel & Aiken, 2013), and had workload led to burnout jeopardizing the processes of caring (Van Bogaert, Clarke, Willems, & Mondelaers, 2013).…”

Section: Introductionmentioning

confidence: 99%

Nursing Duty Hours’ Length and the Perceived Outcomes of Care

Jarrar¹,

Rahman²,

Sebiany³

et al. 2018

GJHS

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Background and objective: Working long shifts are associated with fatigue, medical errors and poor outcomes of care. However, there is a lack of guide that can provide policy-makers the optimal duty length in the Malaysian hospitals. The study aims to investigate the impact of nursing duty hours' length on the quality and safety of care delivered in the "Medical-Surgical Wards" in Malaysia.Method: Cross-sectional study was carried out on 12 private hospitals. Data was collected, through questionnaires, from 652 nurses (61.8 % response rate). Stratified random sampling was used in the study. Regression analyses were conducted to explore the impact of the nursing duty hours' length on the care quality and safety. Findings:The length of nurses' duty hours is not significantly affecting care quality (F = 1.27 and P value = 0.28) and patient safety (F = 1.81 and P value = 0.13), at p<0.05 significance level. Conclusion:Nurse working in hospitals with 10-hours night shift had perceived poor quality (B=-0.11, t=-1.64, p=0.10); and unsafe care (B=-0.17, t=-2.40, p=0.02). Policy makers in Malaysian hospitals can benefit from the study by restructuring duty hours' length in their hospital.

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Adequacy of Dialysis Clinic Staffing and Quality of Care: A Review of Evidence and Areas of Needed Research

Cited by 39 publications

References 64 publications

Association of US Dialysis Facility Staffing with Profiling of Hospital-Wide 30-Day Unplanned Readmission

Association of US Dialysis Facility Staffing with Profiling of Hospital-Wide 30-Day Unplanned Readmission

Patient Care Staffing Levels and Facility Characteristics in US Hemodialysis Facilities

Nursing Duty Hours’ Length and the Perceived Outcomes of Care

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