Day and night nurse staffing levels and hospital-associated disability in older adults in Japan: a retrospective cohort study

Abstract

Background: hospital-associated disability (HAD) in older adults often result from preventable factors. Nurse staffing at the ward level is a key modifiable factor in mitigating HAD.

Objective: to investigate the relationship between nurse staffing shortfalls during typical day and night shifts and risk of HAD in older adults in acute care hospitals.

Design: retrospective cohort study.

Setting: general medical or surgical wards in nine acute care hospitals in Japan.

Subjects: hospital admissions of patients aged ≥65 years.
Methods: Electronic claims data and daily ward-level nursing rosters were used to measure nurse staffing shortfalls based on the patient-to-nurse ratio relative to the annual mean.

Results: Among 57,498 hospital admissions [23,981 (41.7%) female, median age 76 (interquartile range [IQR] 71–82) years], 30,507 (70%) were functionally independent at admission. Functional deterioration occurred in 15,458 (26.9%) admissions. The median (IQR) patient-to-nurse ratio across the whole day was 6.11 (5.54–6.59), 3.70 (3.34–3.90) for the day shift, and 9.38 (8.57–10.37) for the night shift. The median (IQR) deviation from typical ward-level staffing was -0.21 (-0.64 to 0.20) for the whole day, -0.23 (-0.56 to 0.09) for the day shift, and 0.01 (-0.51 to 0.49) for the night shift. For each patient above the mean nurse-to-patient ratio, the risk of HAD increased by 7%.

Conclusion: attention to the deviations from the usual staffing levels for both day and night shifts may be important in efforts to reduce the risk of HAD in older adults.

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Identifiers

ORCID for Christina Saville: orcid.org/0000-0001-7718-5689

ORCID for Peter Griffiths: orcid.org/0000-0003-2439-2857

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