Nurse Staffing Models, Nursing Hours, and Patient Safety Outcomes

Hall, Linda M.; Doran, Diane; Pink, George H.

doi:10.1097/00005110-200401000-00009

Cited by 202 publications

(103 citation statements)

References 9 publications

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“…These problems can often be effectively tackled on a standard ward through proactive patient care led by experienced qualified nursing staff, with prompt access to medical support when required. Adequate staffing of surgical wards with qualified nurses may improve patient safety [28,29] and reduce the incidence of pneumonia, surgical site infection, and postoperative sepsis [30][31][32]. Hospitals with higher nurse staffing levels may also be more cost-effective in terms of postoperative outcomes (lower mortality with similar costs), especially for high-risk surgical patients [33].…”

Section: Discussionmentioning

confidence: 99%

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

et al. 2017

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Purpose: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality.Methods: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. .21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. Results Conclusions:We did not identify any survival benefit from critical care admission following surgery.

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Section: Discussionmentioning

confidence: 99%

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

et al. 2017

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“…Therefore the selection criteria were modified at this time to include these experience practitioners (Table 4.1). Canadian and American studies, 30% of a PICU"s nursing staff population should meet the criteria of experienced PIC nurse for the purpose of this survey (Blegen, Goode & Reed, 1998;Clark, 2002;Hall, Doran & Pink, 2004;Lang, Hodge, Olson, Romano & Kravitz, 2004;Lankshear, Sheldon & Maynard, 2005;Pilcher, Odell, Bray, Clarke, Gardner, Orr & Stirton, 2001;Spetz, 2001). As a conservative estimate, a total of 235 personnel for this study would have met the experienced nurse criteria from within the tertiary hospitals in Australia and New Zealand.…”

Section: Samplementioning

confidence: 98%

Determining standard criteria for endotracheal suctioning in the paediatric intensive care patient: An exploratory study

Davies

Monterosso

Leslie

2011

Intensive and Critical Care Nursing

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This four-phase mixed method study developed an evidence based ‘‘Endotracheal Suction Assessment Tool’’ (ESAT) as a guide for nurses undertaking ‘‘endotracheal tube’’ (ETT) suction within ‘‘Paediatric Intensive Care’’ (PIC). Phase 1 involved a comprehensive literature review to determine the most commonly used criteria for assessing the need for ETT suction. In Phase 2 an ‘‘Endotracheal Suction Questionnaire’’ (ESQ) was developed to survey experienced PIC nurses in Australia and New Zealand regarding their ETT suction decision making process and validity testing of the ESQ. In Phase 3, the ESQ was administered to target group (n = 104). In Phase 4, the empirical evidence generated from this study, based upon the criteria rated by nurses in this study as being most clinically important and essential during the decision making process, determined the ESAT design. Analyses of quantitative results showed a positive correlation between the perceived frequency of use of a criterion and the appropriateness of the assessment. Where a criterion was used less frequently as a clinical indicator for the requirement for ETT suction, participants had a lower regard for this when rating the criterion as a specific single indicator to perform suction. Findings from qualitative data identified six criteria not previously documented within the literature. Further testing and validation of the tool within the PIC setting will determine the clinical viability of the ESAT

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“…A number of these studies found an association between a nursing skill mix that has a higher proportion of RNs and better outcomes including lower mortality / failure to rescue (Blegen et al, 2011, Estabrooks et al, 2005, lower rates of infections (Blegen et al, 2011, Cho et al, 2003, McGillis Hall et al, 2004, falls (Blegen and Vaughn, 1998, Donaldson et al, 2005, Patrician et al, 2011, pressure ulcers (Blegen et al, 2011, Ibe et al, 2008, and higher patient satisfaction (Potter et al, 2003). The overall pattern of results is largely consistent, with the only significant contradictory evidence coming from one of the weaker studies which showed that a higher proportion of registered nurses was associated with a higher nurse reported incidence of pneumonia (Ausserhofer et al, 2013).…”

Section: March 2016mentioning

confidence: 99%

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Griffiths

Ball

Drennan

et al. 2016

International Journal of Nursing Studies

207

216

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What is already known? A number of high quality reviews establish an association between lower registered nurse staffing levels, increased mortality rates and other adverse outcomes  Careful analysis of this evidence suggests that it is consistent with a causal relationship  Translation of this evidence into practice is disputedWhat this paper adds  This paper summarises and extends a recent systematic review on nurse staffing and outcomes undertaken for England's National Institute for Health and Care Excellence  Methodological limitations mean that existing studies may not give unbiased estimates of the benefits from increased nurse staffing, with over and underestimation of benefit both possible, which makes it difficult to directly translate evidence into guidance for practice. We identify avenues for progressing this important research so that future studies might be better able to provide the evidence needed to inform policy and practice, and provide a checklist to aid future study development AbstractA large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as "compelling" and "overwhelming", there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence (NICE), which concluded there is insufficient good quality evidence available to fully inform practice.In this paper we explore this apparent contradiction. After summarising the evidence review that informed the NICE guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey.Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing, it may not provide operational solutions. We conclude by posing a ser...

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Nurse Staffing Models, Nursing Hours, and Patient Safety Outcomes

Cited by 202 publications

References 9 publications

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

Determining standard criteria for endotracheal suctioning in the paediatric intensive care patient: An exploratory study

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

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