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Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study

Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study
Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study
Background:
Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery.

Aim:
Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality.

Method:
Data from the RN4CAST study (2009–2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses’ staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation.

Results:
Nurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse’s workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% (OR 1.068, 95% CI 1.031–1.106) and 16% (OR 1.159 95% CI 1.039–1.294) increase in the odds of a patient dying within 30 days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality.

Conclusion:
Missed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an ‘early warning’ indicator of higher risk for poor patient outcomes.
0020-7489
Ball, Jane E.
85ac7d7a-b21e-42fd-858b-78d263c559c1
Bruyneel, Luk
b1dccbf8-34ee-4b11-b698-790131e1abb0
Aiken, Linda H.
6110096b-bab9-41a7-89f4-d7043011d6d9
Sermeus, Walter
42465ab5-e333-4fe8-9a80-c55f6c15a3ab
Sloane, Douglas M.
10494ba7-bfc5-48db-996e-6773a265864a
Rafferty, Anne Marie
f8585833-856a-4b45-9da2-16103331152e
Lindqvist, Rikard
23451573-1677-473e-8f1a-326c3b72c9ef
Tishelman, Carol
11d9dd11-f992-48d7-b8ef-a9f428a809d6
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
RN4CAST Consortium
Ball, Jane E.
85ac7d7a-b21e-42fd-858b-78d263c559c1
Bruyneel, Luk
b1dccbf8-34ee-4b11-b698-790131e1abb0
Aiken, Linda H.
6110096b-bab9-41a7-89f4-d7043011d6d9
Sermeus, Walter
42465ab5-e333-4fe8-9a80-c55f6c15a3ab
Sloane, Douglas M.
10494ba7-bfc5-48db-996e-6773a265864a
Rafferty, Anne Marie
f8585833-856a-4b45-9da2-16103331152e
Lindqvist, Rikard
23451573-1677-473e-8f1a-326c3b72c9ef
Tishelman, Carol
11d9dd11-f992-48d7-b8ef-a9f428a809d6
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b

Ball, Jane E., Bruyneel, Luk, Aiken, Linda H., Sermeus, Walter, Sloane, Douglas M., Rafferty, Anne Marie, Lindqvist, Rikard, Tishelman, Carol and Griffiths, Peter , RN4CAST Consortium (2017) Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study. International Journal of Nursing Studies. (doi:10.1016/j.ijnurstu.2017.08.004).

Record type: Article

Abstract

Background:
Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery.

Aim:
Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality.

Method:
Data from the RN4CAST study (2009–2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses’ staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation.

Results:
Nurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse’s workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% (OR 1.068, 95% CI 1.031–1.106) and 16% (OR 1.159 95% CI 1.039–1.294) increase in the odds of a patient dying within 30 days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality.

Conclusion:
Missed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an ‘early warning’ indicator of higher risk for poor patient outcomes.

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More information

Accepted/In Press date: 8 August 2017
e-pub ahead of print date: 24 August 2017

Identifiers

Local EPrints ID: 413523
URI: https://eprints.soton.ac.uk/id/eprint/413523
ISSN: 0020-7489
PURE UUID: 902425be-b686-473c-8670-3f4b0fc4dd0c
ORCID for Jane E. Ball: ORCID iD orcid.org/0000-0002-8655-2994
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857

Catalogue record

Date deposited: 25 Aug 2017 16:31
Last modified: 15 Mar 2019 05:01

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