The association between nurse staffing levels and a failure to respond to patients with deranged physiology: a retrospective observational study in the UK
The association between nurse staffing levels and a failure to respond to patients with deranged physiology: a retrospective observational study in the UK
BackgroundResponding 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.
MethodsThis 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.
ResultsThere 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.
ConclusionsRN, 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.
Nursing, Patient deterioration, Policy, Rapid response systems, Vital signs
202-208
Smith, Gary B.
9713f86e-b7d6-4ccb-a81d-ee6c4e76e4c2
Redfern, Oliver
6a813657-1f29-4085-8807-e24e32723e15
Maruotti, Antonello
53159118-f31e-4f3e-b812-dff432d74229
Recio Saucedo, Alejandra
d05c4e43-3399-466d-99e0-01403a04b467
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
April 2020
Smith, Gary B.
9713f86e-b7d6-4ccb-a81d-ee6c4e76e4c2
Redfern, Oliver
6a813657-1f29-4085-8807-e24e32723e15
Maruotti, Antonello
53159118-f31e-4f3e-b812-dff432d74229
Recio Saucedo, Alejandra
d05c4e43-3399-466d-99e0-01403a04b467
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Smith, Gary B., Redfern, Oliver, Maruotti, Antonello, Recio Saucedo, Alejandra and Griffiths, Peter
(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, 149, .
(doi:10.1016/j.resuscitation.2020.01.001).
Abstract
BackgroundResponding 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.
MethodsThis 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.
ResultsThere 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.
ConclusionsRN, 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.
Text
Staffing levels and a failure to respond_accepted online version
- Accepted Manuscript
More information
Accepted/In Press date: 4 January 2020
e-pub ahead of print date: 13 January 2020
Published date: April 2020
Keywords:
Nursing, Patient deterioration, Policy, Rapid response systems, Vital signs
Identifiers
Local EPrints ID: 437227
URI: http://eprints.soton.ac.uk/id/eprint/437227
ISSN: 0300-9572
PURE UUID: be79e183-043a-4cce-8e53-83b8266f95c7
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Date deposited: 22 Jan 2020 17:32
Last modified: 17 Mar 2024 05:14
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Author:
Gary B. Smith
Author:
Oliver Redfern
Author:
Antonello Maruotti
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