Thursday, March 17, 2011

Fewer Nurses, Greater Patient Turnover Boost Hospital Mortality Rates

It always sounds so plausible when health care bean counters justify nursing staff levels that nurses themselves say are insufficient, or the practice of increasing patient turn-over by having shorter in-hospital stays.

Since health care is so costly, and saving money seems almost as important as saving lives, it's easy to take the justifications for lower nursing staff levels and shorter patient stays for granted.

But now, a study suggests that fewer nurses and higher patient turnover may not be good for the health of the patients, that in fact, patient mortality increases.

"We estimate that the risk of death increased by 2% for each below-target shift and 4% for each high-turnover shift to which a patient was exposed," lead author Jack Needleman, PhD, from the University of California–Los Angeles, and coauthors write in the March 17 issue of the New England Journal of Medicine.

According to a Wedscape Today article reporting on this research, the study "findings emphasize the need to match nurse staffing levels with patients' needs for care." But in real life the operative question is who defines what level of staffing provides the optimal match. In many places, including Winnipeg and other Canadian centers, nurses and hospital management sometimes disagree as to what the best staffing level is.

(To access the Webscape article a free registration is required. I recommend Webscape as an invaluable source of multi-specialty health care information.)

Nurses would certainly argue, and with justification, that staff levels should be sufficiently well funded so as to minimize any risk when the staffing level falls below target due to absences caused by illness or work-related stress. Many nurses throughout North America also complain, often with justification, that their concerns are not given much weight by management.

The article noted that the highest rate of staff shortage occurred in critical care units (19.4% of all shifts), compared with general care units, where the percentage of shifts with a shortage, or "below target," was 14%. The overall percentage of below target shifts was 19.4%. 

Compounding the staffing issue is the trend in hospital care to decrease patient hospital stays as much as possible, because the shorter the stay, the less cost per patient. Sometimes it is in the patient's interest to have a shorter stay. However, the research noted a problem with the increased patient turnover associated with shorter stays.

"Patient turnover was deemed a high-risk period because of its pull on nurses' time and attention.," the article said. Admitting and discharging patients requires a nurse's time and attention above and beyond other duties on the unit.

The study approach was a "retrospective, observational analysis of data from a respected, tertiary care academic medical center gathered from 2003 through 2006, representing 43 hospital units, 197,961 patients, and 176,696 eight-hour nursing shifts."

I wonder if similar studies are undertaken by individual hospitals or, in Canada, by the regional health authorities, which may operate several hospitals within their area. For those newspapers and electronic media who still have a dedicated health beat, this research would be a good story to follow-up on for the local angle.







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