Increasing Both Nurse and Doctor Staffing Levels Can Reduce Patient Mortality in ICUs – but Nurses Are Key

A new study in the International Journal of Nursing Studies finds that higher staffing levels for doctors and nurses in intensive care units (ICUs) are associated with higher survival rates for patients at high risk for death. The report, titled “Nurse staffing, medical staffing and mortality in Intensive Care: an observational study,” examines whether the number of nurses, doctors, and support staff affected the survival chances of critically ill patients in both the ICU and the hospital, HealthCanal reports.

Researchers reviewed information on nearly 40,000 patients from 65 ICUs in the United Kingdom. Among the findings, higher numbers of nurses per bed were associated with higher survival rates, and the number of nurses had the greatest impact on patients at a high risk of death when compared to other medical staffing levels.

An INQRI-funded study on the impact of nursing staffing on hospital performance revealed that increasing the number of registered nurse (RN) hours per patient day increased the quality of patient care. The study looked in particular at patients who were being treated for acute myocardial infarction, pneumonia or heart failure.) For all three conditions, increasing the number of RN hours increased the quality of care. This did not hold true for increasing the number of licensed practical nurse or nursing assistant hours.

The study's authors—Gestur Davidson, Ira Moscovice, and Kathy Belk—posited that RNs are involved in and directly affect procedures, practices and processes that directly influence patient outcomes. This was the first study into how nurse staffing affects hospital performance on quality metrics used in the Premier Hospital Quality Demonstration project. It is reviewed in a research brief on the Robert Wood Johnson Foundation website.

Staffing Issues a Factor in Higher Weekend Hospitalization Mortality Rates

Patients hospitalized on weekends are at a 15 percent higher risk of dying due to issues related to nurse and physician staffing and training, according to a new report. Researchers concluded that “low staffing levels of nurses and physicians significantly impact mortality.” Mortality rates were also higher among patients admitted to the hospital on weekends in hospitals with less experienced staff, such as resident trainees.

The study, which is currently available in provisional form, was conducted by researchers from Tufts Medical Center in Boston who examined data on more than 48 million patients admitted to hospitals for non-elective reasons from January 1, 2003-December 31, 2008.

Researchers found that the overall odds of mortality were higher for patients in hospitals with fewer nurses and staff physicians. Hospitals with more nurses or physicians per hospital bed had a 10 percent lower rate of mortality after a weekend admission. Mortality in hospitals with the highest number of resident trainees was 17 percent higher following a weekend admission, compared with hospitals with no resident trainees.

An INQRI study, “The Effect of Off-peak Hospital Environments on Nurses' Work: an Institutional Ethnography” also revealed the negative impact of weekend and evening admissions on mortality rates. The INQRI study showed that nurses’ “off-peak” work environments play a significant role in the increased patient mortality.

In off-peak environments, nurses have less access to support, work with less supervision, and have strained communication with on-call health care providers, the study found. Researchers identified ways in which nurse administrators can mitigate the possible reasons for these disparities:

• Being conscious of the fact that the majority of hours nurses work are “off-peak” and ensuring that institutions’ efforts and programs include peak and “off-peak” times;
• Knowing that implementing a solution for a problem that occurs during peak hours may unintentionally create a problem for those nurses who work “off-peak” and involving nurses from every shift in planning and evaluating work processes;
• Collecting performance data in a way that allows for comparing that data across days of the week and times (both peak and “off-peak”), rather than aggregating data over 24 hours or over an entire week; and
• Proactively addressing nurse-physician relations in the hospital.

The INQRI grantees were Patti Hamilton and Gretchen Gemeinhardt.