Associations of 4 Nurse Staffing Practices With Hospital Mortality

Rochefort, Christian M.; Beauchamp, Marie-Ève; Audet, Li-Anne; Abrahamowicz, Michal; Bourgault, Patricia

doi:10.1097/mlr.0000000000001397

Cited by 23 publications

(45 citation statements)

References 44 publications

(60 reference statements)

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“…Using digitized payroll and patient data, we examined how shift‐to‐shift variations in several nurse staffing practices were related to the risk of all‐cause in‐hospital death. We found that every 5.0% increase in the cumulative proportion of understaffed shifts since hospital admission was associated with a 1.0% increase in the risk of death (Rochefort et al., 2020). Moreover, we noted that every 5.0% increase in the cumulative proportion of worked hours by baccalaureate‐prepared Registered Nurses (RNs) decreased the risk of death by 2.0%.…”

Section: Introductionmentioning

confidence: 92%

“…Moreover, we noted that every 5.0% increase in the cumulative proportion of worked hours by baccalaureate‐prepared Registered Nurses (RNs) decreased the risk of death by 2.0%. Last, we found that RNs’ levels of experience and the proportion of non‐RN staff were not related to the risk of death (Rochefort et al., 2020).…”

Section: Introductionmentioning

confidence: 95%

“…To adjust for unit‐specific work environment characteristics that may have an impact on nurses’ work (Rochefort et al., 2020; Stalpers et al., 2015), a time‐varying variable representing the current unit of hospitalization will be measured. In addition, time‐varying covariates will be used to characterize the current: (a) unit of hospitalization as a medical, surgical, or intensive care unit, (b) day (weekday or weekend); (c) shift of hospitalization (night, day or evening); and (d) unit occupancy as observed at the beginning of the current shift.…”

Section: The Studymentioning

confidence: 99%

“…Research over the past decades has suggested that many nurse staffing practices in acute care hospitals (e.g., using higher nurse‐to‐patient ratios, overtime hours or less qualified staff) are associated with higher rates of mortality and adverse events (AEs) (Audet et al., 2018; Bae & Fabry, 2014; Griffiths, Recio‐Saucedo, et al, 2018; Stalpers et al., 2015). While these studies have made important contributions to the field, the validity of the evidence they have provided has been questioned for two main reasons (Rochefort et al., 2020).…”

Section: Introductionmentioning

confidence: 99%

“…First, most these studies relied on cross‐sectional designs which preclude the assessment of the temporal sequence linking an exposure to its presumed outcome (Costa & Yakusheva, 2016; Rochefort et al., 2020). Consequently, whether the occurrence of an AE can be attributed to patient antecedent exposure to a suboptimal nurse staffing practice is uncertain (Audet et al., 2018).…”

Section: Introductionmentioning

confidence: 99%

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Nurse staffing practices and adverse events in acute care hospitals: The research protocol of a multisite patient‐level longitudinal study

Rochefort

Abrahamowicz

Biron

et al. 2020

Journal of Advanced Nursing

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Aims We describe an innovative research protocol to: (a) examine patient‐level longitudinal associations between nurse staffing practices and the risk of adverse events in acute care hospitals and; (b) determine possible thresholds for safe nurse staffing. Design A dynamic cohort of adult medical, surgical and intensive care unit patients admitted to 16 hospitals in Quebec (Canada) between January 2015–December 2019. Methods Patients in the cohort will be followed from admission until 30‐day postdischarge to assess exposure to selected nurse staffing practices in relation to the subsequent occurrence of adverse events. Five staffing practices will be measured for each shift of an hospitalization episode, using electronic payroll data, with the following time‐varying indicators: (a) nursing worked hours per patient; (b) skill mix; (c) overtime use; (d) education mix and; and (e) experience. Four high‐impact adverse events, presumably associated with nurse staffing practices, will be measured from electronic health record data retrieved at the participating sites: (a) failure‐to‐rescue; (b) in‐hospital falls; (c) hospital‐acquired pneumonia and; and (d) venous thromboembolism. To examine the associations between the selected nurse staffing exposures and the risk of each adverse event, separate multivariable Cox proportional hazards frailty regression models will be fitted, while adjusting for patient, nursing unit and hospital characteristics, and for clustering. To assess for possible staffing thresholds, flexible non‐linear spline functions will be fitted. Funding for the study began in October 2019 and research ethics/institutional approval was granted in February 2020. Discussion To our knowledge, this study is the first multisite patient‐level longitudinal investigation of the associations between common nurse staffing practices and the risk of adverse events. It is hoped that our results will assist hospital managers in making the most effective use of the scarce nursing resources and in identifying staffing practices that minimize the occurrence of adverse events.

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Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 95%

Section: The Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Nurse staffing practices and adverse events in acute care hospitals: The research protocol of a multisite patient‐level longitudinal study

Rochefort

Abrahamowicz

Biron

et al. 2020

Journal of Advanced Nursing

Self Cite

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Association of Registered Nurse Staffing With Mortality Risk of Medicare Beneficiaries Hospitalized With Sepsis

Cimiotti

Becker

et al. 2022

JAMA Health Forum

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IMPORTANCESepsis is a major physiologic response to infection that if not managed properly can lead to multiorgan failure and death. The US Centers for Medicare & Medicaid Services (CMS) requires that hospitals collect data on core sepsis measure Severe Sepsis and Septic Shock Management Bundle (SEP-1) in an effort to promote the early recognition and treatment of sepsis.Despite implementation of the SEP-1 measure, sepsis-related mortality continues to challenge acute care hospitals nationwide. OBJECTIVE To determine if registered nurse workload was associated with mortality in Medicare beneficiaries admitted to an acute care hospital with sepsis. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used 2018 data from the American Hospital Association Annual Survey, CMS Hospital Compare, and Medicare claims on Medicare beneficiaries age 65 to 99 years with a primary diagnosis of sepsis that was present on admission to 1 of 1958 nonfederal, general acute care hospitals that had data on CMS SEP-1 scores and registered nurse workload (indicated by registered nurse hours per patient day [HPPD]). Patients with sepsis were identified based on 29 International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. Data were analyzed throughout 2021. EXPOSURES SEP-1 score and registered nurse staffing. MAIN OUTCOMES AND MEASURESThe patient outcome of interest was mortality within 60 days of admission. Hospital characteristics included number of beds, ownership, teaching status, technology status, rurality, and region. Patient characteristics included age, sex, transfer status, intensive care unit admission, palliative care, do-not-resuscitate order, and a series of 29 comorbid diseases based on the Elixhauser Comorbidity Index. RESULTSIn total, 702 140 Medicare beneficiaries (mean [SD] age, 78.2 [8.7] years; 360 804 women [51%]) had a diagnosis of sepsis. The mean SEP-1 score was 56.1, and registered nurse HPPD was 6.2. In a multivariable regression model, each additional registered nurse HPPD was associated with a 3% decrease in the odds of 60-day mortality (odds ratio, 0.97; 95% CI 0.96-0.99) controlling for SEP-1 score and hospital and patient characteristics. CONCLUSIONS AND RELEVANCEThe results of this cross-sectional study suggest that hospitals that provide more registered nurse hours of care could likely improve SEP-1 bundle compliance and decrease the likelihood of mortality in Medicare beneficiaries with sepsis.

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Benchmark and performance progression: Examining the roles of market competition and focus

Ding

2024

J of Ops Management

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As the US healthcare system transitions from volume to value, various value‐based programs tie medical reimbursements to hospital performance relative to national top performers (i.e., benchmarks). However, prior studies report very limited results on how such benchmarks affect care delivery and patient outcomes across multiple performance fronts. This study examines how general acute care hospitals progress toward benchmarks measured by performance frontiers in technical efficiency, clinical quality, and patient experience over time, subjecting to external market conditions and internal focuses. Based on a panel dataset comprising hospitals in California from 2012 and 2019, our results find support for competitive‐distance‐driven progression rates, suggesting that hospitals' competitive positions measured by their distances to benchmarks drive performance improvements. Yet, the effect diminishes as they move closer to performance frontiers. In addition, we find that market competition reduces the progression rate of technical efficiency. Finally, our results also suggest that focus improves performance progression rates, yet its effects are curvilinear.

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Associations of 4 Nurse Staffing Practices With Hospital Mortality

Abstract: Supplemental Digital Content is available in the text.

Cited by 23 publications

References 44 publications

Nurse staffing practices and adverse events in acute care hospitals: The research protocol of a multisite patient‐level longitudinal study

Nurse staffing practices and adverse events in acute care hospitals: The research protocol of a multisite patient‐level longitudinal study

Association of Registered Nurse Staffing With Mortality Risk of Medicare Beneficiaries Hospitalized With Sepsis

Benchmark and performance progression: Examining the roles of market competition and focus

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