Patient Care Staffing Levels and Facility Characteristics in US Hemodialysis Facilities

Abstract

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.

An effective approach to chronic kidney disease in South Africa

“…While this may raise some concerns, these ratios do prevail in dialysis units in high-income countries. [7] The risks are those of greater burnout and reducing the quality of care, although there are limited data to support this as yet. [8] However, with the current gene ration of dialysis machines equipped with vastly improved technology and safety features, a different level of nursing oversight is required.…”

Living Donor Kidney Transplantation

“…Some transplant centers are establishing outreach clinics to reduce the burden of transplant evaluation for interested patients by providing onsite medical testing and education in rural locations or in cities several hours away from their centers (70). Nonprofit dialysis organizations, which more commonly serve rural patients (64,72,73), may have the infrastructure and patient contact to widely disseminate LDKT education among patients outside of urban areas. Because screening and outreach programs require additional resources to implement and evaluate, partnerships between kidney and transplant organizations already providing outreach (see Table 2), researchers, dialysis organizations, and transplant centers should be fostered to examine how outreach can be conducted efficiently within already existing organizational capacities.…”

The Size and Scope of Collegiate Athletic Training Facilities and Staffing

“…Although approximately 24% of the National Athletic Trainers' Association's (NATA's) certified members are employed in the collegiate or university setting, very little is known about current athletic training staffing patterns or athletic training facilities at the intercollegiate level. The lack of published research in this area is surprising given that research [2][3][4][5] in other health care professions has shown that staffing levels and facilities affect patient outcomes. Lower staff-to-patient ratios and better facilities improve quality-of-care outcomes and reduce mortality rates.…”