Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals

McHugh, Matthew D.; Aiken, Linda H.; Sloane, Douglas M.; Windsor, Carol; Douglas, Clint; Yates, Patsy

doi:10.1016/s0140-6736(21)00768-6

Cited by 166 publications

(139 citation statements)

References 29 publications

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“…Standard of care depends on the entirety of the available medical resources, such as pharmaceutics, diagnostic interventions, hospital and intensive care unit (ICU) beds, technical organ support, and, in particular, trained critical care staff including respiratory therapists, dialysis specialists, and ICU nurses [ 11 ]. Throughout the world, the COVID-19 pandemic continues to have a dramatic impact on the availability of these resources [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Prolonged Hospital Length of Stay in Adults with Imported Falciparum Malaria—An Observational Study from a Tertiary Care University Hospital in Berlin, Germany

Hoffmeister

2021

Microorganisms

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Outcome of falciparum malaria is largely influenced by the standard of care provided, which in turn depends on the available medical resources. Worldwide, the COVID-19 pandemic has had a major impact on the availability of these resources, even in resource-rich healthcare systems such as Germany’s. The present study aimed to determine the under-explored factors associated with hospital length of stay (LOS) in imported falciparum malaria to identify potential targets for improving management. This retrospective observational study used multivariate Cox proportional hazard regression with time to discharge as an endpoint for adults hospitalized between 2001 and 2015 with imported falciparum malaria in the Charité University Hospital, Berlin. The median LOS of the 535 cases enrolled was 3 days (inter-quartile range, IQR, 3–4 days). The likelihood of being discharged by day 3 strongly decreased with severe malaria (hazard ratio, HR, 0.274; 95% Confidence interval, 95%CI: 0.190–0.396) and by 40% with each additional presenting complication (HR, 0.595; 95%CI: 0.510–0.694). The 55 (10.3%) severe cases required a median LOS of 7 days (IQR, 5–12 days). In multivariate analysis, occurrence of shock (adjusted HR, aHR, 0.438; 95%CI 0.220–0.873), acute pulmonary oedema or acute respiratory distress syndrome (aHR, 0.450; 95%CI: 0.223–0.874), and the need for renal replacement therapy (aHR, 0.170; 95%CI: 0.063–0.461) were independently associated with LOS. All patients survived to discharge. This study illustrates that favourable outcomes can be achieved with high-standard care in imported falciparum malaria. Early recognition of disease severity together with targeted supportive care can lead to avoidance of manifest organ failure, thereby potentially decreasing LOS and alleviating pressure on bed capacities.

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Section: Introductionmentioning

confidence: 99%

Factors Associated with Prolonged Hospital Length of Stay in Adults with Imported Falciparum Malaria—An Observational Study from a Tertiary Care University Hospital in Berlin, Germany

Hoffmeister

2021

Microorganisms

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“…Studies were published between 2003 and 2021. Most studies collected data from one hospital only (n= 15), but there were some notable exceptions, for example McHugh et al included 55 hospitals, 19 Hamilton et al included 54 hospitals, 20 and Mark and Belyea included 145 hospitals. Patient samples ranged between 85 14 and 489,155.…”

Section: Resultsmentioning

confidence: 99%

“…Patient samples ranged between 85 14 and 489,155. 19 In terms of settings, 11 studies were conducted in Intensive Care Units (ICU); three in Acute Medical Units; thirteen in a variety of inpatient wards, which could also include ICUs. Most studies (n=9) were conducted in the US, 5 in the UK, 4 in Canada, 3 each in Italy, Australia and Switzerland, and one in Finland.…”

Section: Resultsmentioning

confidence: 99%

“…15 In studies considering policy implementations, staffing and outcomes relationships were measured one year after implementation. 18 19 Thirteen studies considered staffing levels averaged or summed cumulatively for the whole patient stay. 13 16 17 20 22-30 Six studies considered staffing in the early part of the patient stay only, ranging between the first day and the first seven days of the patients’ stay.…”

Section: Resultsmentioning

confidence: 99%

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Nurse staffing levels and patient outcomes: a systematic review of longitudinal studies

Dall’Ora

Saville

Rubbo

et al. 2021

Preprint

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Background: The contribution of registered nurses (RN) towards safe patient care has been demonstrated by several studies. However, most of the evidence is cross-sectional, hence the inability to demonstrate that staffing levels precede patient outcomes. No reviews have summarised longitudinal studies considering nurse staffing and patient outcomes. Objectives: To synthesise longitudinal studies focusing on associations between nurse staffing levels and patient outcomes. Methods: Systematic review. We conducted our search in 2020 and updated it in July 2021. We searched Medline, CINAHL, Embase and the Cochrane Library. We used the ROBINS-I tool for assessing risk of bias. We reported results narratively grouped by outcome. Results: 28 papers were included. Most studies were either at serious (n=12) or critical (n=6) risk of bias, with 3 studies at low risk of bias. Studies were conducted in a variety of settings and populations. Notwithstanding the limitations, findings are consistent with an overall picture of a beneficial effect from higher RN staffing on preventing patient death. Studies with the greatest risk of bias were judged as most likely to underestimate the effect of higher RN staffing. The evidence is less clear for other patient outcomes, but estimates, though at moderate or serious risk of bias, indicate that higher RN staffing is likely to lead to better patient outcomes. Evidence about the contribution of other nursing staff groups and skill mix of the team is unclear. Conclusion: There is a likely causal relationship between low RN staffing and harm to patients, although uncertainties remain regarding the magnitude of effect. To address these uncertainties, future studies should be conducted in more than one hospital and using standardised measures when reporting staffing levels.

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“…In some countries, such as Norway, approaches to nurse staffing are determined locally. Other countries have policy-led approaches, for instance the RAFAELA system in use in Finland, which was the result of a multi-centre study and national testing during 2000-2002(Kautto, 2016. Finally, in a small but growing number of countries, nurse staffing strategies are enshrined in law.…”

Section: International Study Contextmentioning

confidence: 99%

Pro‐judge study: Nurses’ professional judgement in nurse staffing systems

Jacob

Burton

Hale

et al. 2021

Journal of Advanced Nursing

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Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals

Cited by 166 publications

References 29 publications

Factors Associated with Prolonged Hospital Length of Stay in Adults with Imported Falciparum Malaria—An Observational Study from a Tertiary Care University Hospital in Berlin, Germany

Factors Associated with Prolonged Hospital Length of Stay in Adults with Imported Falciparum Malaria—An Observational Study from a Tertiary Care University Hospital in Berlin, Germany

Nurse staffing levels and patient outcomes: a systematic review of longitudinal studies

Pro‐judge study: Nurses’ professional judgement in nurse staffing systems

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