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The association between ward staffing levels, mortality and hospital readmission in older hospitalised adults, according to presence of cognitive impairment: a retrospective cohort study

The association between ward staffing levels, mortality and hospital readmission in older hospitalised adults, according to presence of cognitive impairment: a retrospective cohort study
The association between ward staffing levels, mortality and hospital readmission in older hospitalised adults, according to presence of cognitive impairment: a retrospective cohort study
Background: lower nurse staffing levels are associated with increased hospital mortality. Older patients with cognitive impairments have higher mortality rates than similar patients without cognitive impairments and may be additionally vulnerable to low staffing.

Objectives: to explore associations between registered nurse (RN) and nursing assistant (NA) staffing levels, mortality and readmission in older patients admitted to general medical/surgical wards.

Research Design: retrospective cohort.

Participants: all unscheduled admissions to an English hospital of people aged ≥75 with cognitive screening over 14 months.

Measures: the exposure was defined as deviation in staffing hours from the ward daily mean, averaged across the patient stay. Outcomes were mortality in hospital/ within 30 days of discharge and 30-day re-admission. Analyses were stratified by cognitive impairment.

Results: 12,544 admissions were included. Patients with cognitive impairment (33.2%) were exposed to similar levels of staffing as those without. An additional 0.5 RN hours per day was associated with 10% reduction in the odds of death overall (Odds Ratio 0.90 [95% CI 0.84-0.97]): 15% in patients with cognitive impairment (OR 0.85 [0.74-0.98]) and 7% in patients without (OR 0.93 [0.85-1.02]). An additional 0.5 NA hours per day was associated with a 15% increase in mortality in patients with no impairment. Readmissions decreased by 6% for an additional 0.5 RN hours in patients with cognitive impairment.

Conclusions: although exposure to low staffing was similar, the impact on mortality and readmission for patients with cognitive impairment was greater. Increased mortality with higher NA staffing in patients without cognitive impairment needs exploration.


0002-0729
431-439
Fogg, Carole
42057537-d443-462a-8944-c804252c973b
Bridges, Jackie
57e80ebe-ee5f-4219-9bbc-43215e8363cd
Meredith, Paul
d0a0e287-ad7f-41cb-9347-94d7a0e957c1
Spice, Claire
ba2a1859-2a1b-43f1-9c52-894b5a38b349
Field, Linda
b6ef84b7-e7c0-4a44-b94f-893940bf0c9d
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Fogg, Carole
42057537-d443-462a-8944-c804252c973b
Bridges, Jackie
57e80ebe-ee5f-4219-9bbc-43215e8363cd
Meredith, Paul
d0a0e287-ad7f-41cb-9347-94d7a0e957c1
Spice, Claire
ba2a1859-2a1b-43f1-9c52-894b5a38b349
Field, Linda
b6ef84b7-e7c0-4a44-b94f-893940bf0c9d
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b

Fogg, Carole, Bridges, Jackie, Meredith, Paul, Spice, Claire, Field, Linda, Culliford, David and Griffiths, Peter (2020) The association between ward staffing levels, mortality and hospital readmission in older hospitalised adults, according to presence of cognitive impairment: a retrospective cohort study. Age and Ageing, 50 (2), 431-439, [afaa133]. (doi:10.1093/ageing/afaa133).

Record type: Article

Abstract

Background: lower nurse staffing levels are associated with increased hospital mortality. Older patients with cognitive impairments have higher mortality rates than similar patients without cognitive impairments and may be additionally vulnerable to low staffing.

Objectives: to explore associations between registered nurse (RN) and nursing assistant (NA) staffing levels, mortality and readmission in older patients admitted to general medical/surgical wards.

Research Design: retrospective cohort.

Participants: all unscheduled admissions to an English hospital of people aged ≥75 with cognitive screening over 14 months.

Measures: the exposure was defined as deviation in staffing hours from the ward daily mean, averaged across the patient stay. Outcomes were mortality in hospital/ within 30 days of discharge and 30-day re-admission. Analyses were stratified by cognitive impairment.

Results: 12,544 admissions were included. Patients with cognitive impairment (33.2%) were exposed to similar levels of staffing as those without. An additional 0.5 RN hours per day was associated with 10% reduction in the odds of death overall (Odds Ratio 0.90 [95% CI 0.84-0.97]): 15% in patients with cognitive impairment (OR 0.85 [0.74-0.98]) and 7% in patients without (OR 0.93 [0.85-1.02]). An additional 0.5 NA hours per day was associated with a 15% increase in mortality in patients with no impairment. Readmissions decreased by 6% for an additional 0.5 RN hours in patients with cognitive impairment.

Conclusions: although exposure to low staffing was similar, the impact on mortality and readmission for patients with cognitive impairment was greater. Increased mortality with higher NA staffing in patients without cognitive impairment needs exploration.


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The association between ward staffing levels, mortality and hospital readmission in older hospitalised adults, according to presence of cognitive impairment a retrospective cohort study - Accepted Manuscript
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Accepted/In Press date: 13 May 2020
e-pub ahead of print date: 24 September 2020

Identifiers

Local EPrints ID: 441384
URI: http://eprints.soton.ac.uk/id/eprint/441384
ISSN: 0002-0729
PURE UUID: 21c25af3-c381-4d43-aa0f-25920f3bbee3
ORCID for Carole Fogg: ORCID iD orcid.org/0000-0002-3000-6185
ORCID for Jackie Bridges: ORCID iD orcid.org/0000-0001-6776-736X
ORCID for David Culliford: ORCID iD orcid.org/0000-0003-1663-0253
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857

Catalogue record

Date deposited: 11 Jun 2020 16:30
Last modified: 26 Nov 2021 07:17

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Contributors

Author: Carole Fogg ORCID iD
Author: Jackie Bridges ORCID iD
Author: Paul Meredith
Author: Claire Spice
Author: Linda Field
Author: David Culliford ORCID iD
Author: Peter Griffiths ORCID iD

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