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The association between nurse staffing levels and a failure to respond to patients with deranged physiology: A retrospective observational study in the UK.

Abstract

BACKGROUND

Responding to abnormalities in patients' vital signs is a fundamental aspect of nursing. However, failure to respond to patient deterioration is common and often leads to adverse patient outcomes. This study aimed to determine the association between Registered Nurse (RN) and Nursing Assistant (NA) staffing levels and the failure to respond promptly to patients' abnormal physiology.

METHODS

This retrospective, observational study used routinely collected patients' vital signs and administrative data, including nursing staffing, from 32 general wards of an acute hospital in England between April 2012 and March 2015. Mixed-effects binomial regression was used to model the relationship between nurse staffing, measured as 'Hours per Patient Day' (HPPD), and a composite primary outcome representing failure to respond for patients with National Early Warning Score (NEWS) values > 6 and > 7.

RESULTS

There were 189,123 NEWS values ≥ 6 and 114,504 NEWS values > 7, affecting 28,098 patients. For patients with NEWS values > 7, failure to respond was significantly associated with levels of RN HPPD ((IRR 0.98, 95% CI 0.96-0.99, p = 0.0001) but not NA HPPD (((IRR 0.99, 95%CI 0.96-1.01, p = 0.238). For patients with NEWS values > 6, no such relationship existed.

CONCLUSIONS

RN, but not NA, staffing levels influence the rates of failure to respond for patients with the most abnormal vital signs (NEWS values > 7). These findings offer a possible explanation for the increasingly reported association between low RN staffing and an increased risk of patient death during a hospital admission.

Authors+Show Affiliations

Faculty of Health and Social Sciences, University of Bournemouth, Bournemouth, UK. Electronic address: gbsresearch@virginmedia.com.Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.Dipartimento di Scienze Economiche, Libera Universita Maria Santissima Assunta, Roma, Italy.NIHR Collaboration for Leadership in Applied Heath Research and Care (Wessex), University of Southampton, Southampton, UK.NIHR Collaboration for Leadership in Applied Heath Research and Care (Wessex), University of Southampton, Southampton, UK.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31945427

Citation

Smith, Gary B., et al. "The Association Between Nurse Staffing Levels and a Failure to Respond to Patients With Deranged Physiology: a Retrospective Observational Study in the UK." Resuscitation, 2020.
Smith GB, Redfern O, Maruotti A, et al. The association between nurse staffing levels and a failure to respond to patients with deranged physiology: A retrospective observational study in the UK. Resuscitation. 2020.
Smith, G. B., Redfern, O., Maruotti, A., Recio-Saucedo, A., & Griffiths, P. (2020). The association between nurse staffing levels and a failure to respond to patients with deranged physiology: A retrospective observational study in the UK. Resuscitation, doi:10.1016/j.resuscitation.2020.01.001.
Smith GB, et al. The Association Between Nurse Staffing Levels and a Failure to Respond to Patients With Deranged Physiology: a Retrospective Observational Study in the UK. Resuscitation. 2020 Jan 13; PubMed PMID: 31945427.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association between nurse staffing levels and a failure to respond to patients with deranged physiology: A retrospective observational study in the UK. AU - Smith,Gary B, AU - Redfern,Oliver, AU - Maruotti,Antonello, AU - Recio-Saucedo,Alejandra, AU - Griffiths,Peter, AU - ,, Y1 - 2020/01/13/ PY - 2019/11/07/received PY - 2019/12/24/revised PY - 2020/01/04/accepted PY - 2020/1/17/pubmed PY - 2020/1/17/medline PY - 2020/1/17/entrez KW - Nursing KW - Patient deterioration KW - Policy KW - Rapid response systems KW - Vital signs JF - Resuscitation JO - Resuscitation N2 - BACKGROUND: Responding to abnormalities in patients' vital signs is a fundamental aspect of nursing. However, failure to respond to patient deterioration is common and often leads to adverse patient outcomes. This study aimed to determine the association between Registered Nurse (RN) and Nursing Assistant (NA) staffing levels and the failure to respond promptly to patients' abnormal physiology. METHODS: This retrospective, observational study used routinely collected patients' vital signs and administrative data, including nursing staffing, from 32 general wards of an acute hospital in England between April 2012 and March 2015. Mixed-effects binomial regression was used to model the relationship between nurse staffing, measured as 'Hours per Patient Day' (HPPD), and a composite primary outcome representing failure to respond for patients with National Early Warning Score (NEWS) values > 6 and > 7. RESULTS: There were 189,123 NEWS values ≥ 6 and 114,504 NEWS values > 7, affecting 28,098 patients. For patients with NEWS values > 7, failure to respond was significantly associated with levels of RN HPPD ((IRR 0.98, 95% CI 0.96-0.99, p = 0.0001) but not NA HPPD (((IRR 0.99, 95%CI 0.96-1.01, p = 0.238). For patients with NEWS values > 6, no such relationship existed. CONCLUSIONS: RN, but not NA, staffing levels influence the rates of failure to respond for patients with the most abnormal vital signs (NEWS values > 7). These findings offer a possible explanation for the increasingly reported association between low RN staffing and an increased risk of patient death during a hospital admission. SN - 1873-1570 UR - https://www.unboundmedicine.com/medline/citation/31945427/The_association_between_nurse_staffing_levels_and_a_failure_to_respond_to_patients_with_deranged_physiology:_A_retrospective_observational_study_in_the_UK L2 - https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(20)30014-9 DB - PRIME DP - Unbound Medicine ER -