Is there an association between hospital staffing levels and inpatient-COVID-19 mortality rates?

Abstract

Objective This study aims to investigate the relationship between RNs and hospital-based medical specialties staffing levels with inpatient COVID-19 mortality rates. Methods We relied on data from AHA Annual Survey Database, Area Health Resource File, and UnitedHealth Group Clinical Discovery Database. In phase 1 of the analysis, we estimated the risk-standardized event rates (RSERs) based on 95,915 patients in the UnitedHealth Group Database 1,398 hospitals. We then used beta regression to analyze the association between hospital- and county- level factors with risk-standardized inpatient COVID-19 mortality rates from March 1, 2020, through December 31, 2020. Results Higher staffing levels of RNs and emergency medicine physicians were associated with lower COVID-19 mortality rates. Moreover, larger teaching hospitals located in urban settings had higher COVID-19 mortality rates. Finally, counties with greater social vulnerability, specifically in terms of housing type and transportation, and those with high infection rates had the worst patient mortality rates. Conclusion Higher staffing levels are associated with lower inpatient mortality rates for COVID-19 patients. More research is needed to determine appropriate staffing levels and how staffing levels interact with other factors such as teams, leadership, and culture to impact patient care during pandemics.

Interprofessional Care Team, Staffing, and Setting Characteristics that Impact Patient Outcomes: A Review of Reviews

“…For example, hospitals equipped to perform open heart surgeries were used as proxy for more advanced equipment and technological capacity than those who do not perform open heart surgery, but it is unclear whether this denotes a substantive difference in organizational capacity or resources compared to a hospital that does not perform open heart surgeries. Data suggests that community level factors such as urbanicity, county socioeconomic status, and housing type may shape the patient population served by the organization, which impacts both care delivery and outcomes,(10) so these factors need to be considered when examining the impacts of staffing and workforce issues.…”

“…Patient outcomes also differ due to characteristics such as comorbidities, mental health problems, and social determinants of health (SDOH), a set of social and environmental factors underlying health inequities. (10) Increases in inpatient assessment of SDOH have improved the care teams’ ability to identify patients with higher social and support needs; those needs require interprofessional services and support alongside nursing care to improve equity and optimize patient outcomes. (11) With ongoing shortages of healthcare workers across multiple professions and documented burnout among RNs, it is critical to understand how care team composition in acute care settings affects outcomes for both patients and workers.…”

A systematic review of interventions to reduce mechanical restraint in adult mental health inpatient settings

“…In the present review, we found that interventions that focus on staff resources may also help reduce the use of MR. This is not surprising as increased staffing has repeatedly proven to optimise healthcare services, including during the recent coronavirus pandemic (Al‐Amin et al., 2022). However, other ways may also be used to improve interventions between patients and staff to reduce MR beyond those identified in this review.…”