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A comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza.
Med Care. 2010 Mar; 48(3):224-32.MC

Abstract

BACKGROUND

Hospital occupancy, nurse staffing levels, weekend admission, and seasonal influenza have all been shown to be associated with in-hospital mortality. Yet, no study has simultaneously compared the strength of associations of these 4 factors with in-hospital mortality.

OBJECTIVE

To compare the risk of in-hospital mortality conferred by high hospital occupancy on admission, increased nurse staffing levels, weekend admission, and seasonal influenza.

STUDY DESIGN

Retrospective cohort study of 166,920 patients admitted to 39 Michigan hospitals between 2003 and 2006. Participants were adults, age > or = 65 years, admitted through the emergency department with 6 common discharge diagnoses (acute myocardial infarction, congestive heart failure, stroke, pneumonia, hip fracture, gastrointestinal bleeding). We used logistic regression to compare the differences in the predicted probability of death conferred by each of the 4 factors, controlling for patient age, gender, discharge diagnosis, and comorbid conditions.

RESULTS

Each of the 4 factors had a statistically significant, independent association with in-hospital mortality. Seasonal influenza conferred the greatest increase in absolute risk of in-hospital mortality (0.5 percentage points; 95% CI, 0.23-0.76), followed by weekend admission (0.32, 0.11-0.54), and high hospital occupancy on admission (0.24, 0.06-0.43). Increased nurse staffing levels decreased the absolute risk of mortality by 0.25 percentage points (0.04-0.48) for each additional full-time equivalent nurse per patient-day.

CONCLUSION

Hospital occupancy, nurse staffing levels, weekend admission, and seasonal influenza all appear to be independently associated with in-hospital mortality, but to varying degrees in the current sample. These findings may guide hospital administrators as they consider factors that influence weekly and seasonal patient flow and capacity, as well as staffing.

Authors+Show Affiliations

Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI 48109, USA. petschil@med.umich.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

20168260

Citation

Schilling, Peter L., et al. "A Comparison of In-hospital Mortality Risk Conferred By High Hospital Occupancy, Differences in Nurse Staffing Levels, Weekend Admission, and Seasonal Influenza." Medical Care, vol. 48, no. 3, 2010, pp. 224-32.
Schilling PL, Campbell DA, Englesbe MJ, et al. A comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza. Med Care. 2010;48(3):224-32.
Schilling, P. L., Campbell, D. A., Englesbe, M. J., & Davis, M. M. (2010). A comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza. Medical Care, 48(3), 224-32. https://doi.org/10.1097/MLR.0b013e3181c162c0
Schilling PL, et al. A Comparison of In-hospital Mortality Risk Conferred By High Hospital Occupancy, Differences in Nurse Staffing Levels, Weekend Admission, and Seasonal Influenza. Med Care. 2010;48(3):224-32. PubMed PMID: 20168260.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza. AU - Schilling,Peter L, AU - Campbell,Darrell A,Jr AU - Englesbe,Michael J, AU - Davis,Matthew M, PY - 2010/2/20/entrez PY - 2010/2/20/pubmed PY - 2010/3/23/medline SP - 224 EP - 32 JF - Medical care JO - Med Care VL - 48 IS - 3 N2 - BACKGROUND: Hospital occupancy, nurse staffing levels, weekend admission, and seasonal influenza have all been shown to be associated with in-hospital mortality. Yet, no study has simultaneously compared the strength of associations of these 4 factors with in-hospital mortality. OBJECTIVE: To compare the risk of in-hospital mortality conferred by high hospital occupancy on admission, increased nurse staffing levels, weekend admission, and seasonal influenza. STUDY DESIGN: Retrospective cohort study of 166,920 patients admitted to 39 Michigan hospitals between 2003 and 2006. Participants were adults, age > or = 65 years, admitted through the emergency department with 6 common discharge diagnoses (acute myocardial infarction, congestive heart failure, stroke, pneumonia, hip fracture, gastrointestinal bleeding). We used logistic regression to compare the differences in the predicted probability of death conferred by each of the 4 factors, controlling for patient age, gender, discharge diagnosis, and comorbid conditions. RESULTS: Each of the 4 factors had a statistically significant, independent association with in-hospital mortality. Seasonal influenza conferred the greatest increase in absolute risk of in-hospital mortality (0.5 percentage points; 95% CI, 0.23-0.76), followed by weekend admission (0.32, 0.11-0.54), and high hospital occupancy on admission (0.24, 0.06-0.43). Increased nurse staffing levels decreased the absolute risk of mortality by 0.25 percentage points (0.04-0.48) for each additional full-time equivalent nurse per patient-day. CONCLUSION: Hospital occupancy, nurse staffing levels, weekend admission, and seasonal influenza all appear to be independently associated with in-hospital mortality, but to varying degrees in the current sample. These findings may guide hospital administrators as they consider factors that influence weekly and seasonal patient flow and capacity, as well as staffing. SN - 1537-1948 UR - https://www.unboundmedicine.com/medline/citation/20168260/A_comparison_of_in_hospital_mortality_risk_conferred_by_high_hospital_occupancy_differences_in_nurse_staffing_levels_weekend_admission_and_seasonal_influenza_ L2 - https://doi.org/10.1097/MLR.0b013e3181c162c0 DB - PRIME DP - Unbound Medicine ER -