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Association between Nurse Staffing and In-Hospital Bone Fractures: A Retrospective Cohort Study.

ABSTRACT: To determine if sufficient nurse staffing reduced in-hospital fractures in acute care hospitals.The Japanese Diagnosis Procedure Combination inpatient (DPC) database from July 2010 to March 2014 linked with the Surveys for Medical Institutions.We conducted a retrospective cohort study to examine the association of inpatient nurse-to-occupied bed ratio (NBR) with in-hospital fractures. Multivariable logistic regression with generalized estimating equations was performed, adjusting for patient characteristics and hospital characteristics.We identified 770,373 patients aged 50 years or older who underwent planned major surgery for some forms of cancer or cardiovascular diseases. We used ICD-10 codes and postoperative procedure codes to identify patients with in-hospital fractures. Hospital characteristics were obtained from the "Survey of Medical Institutions and Hospital Report" and "Annual Report for Functions of Medical Institutions."Overall, 662 (0.09 percent) in-hospital fractures were identified. Logistic regression analysis showed that the proportion of in-hospital fractures in the group with the highest NBR was significantly lower than that in the group with the lowest NBR (adjusted odd ratios, 0.67; 95 percent confidence interval, 0.44-0.99; p = .048).Sufficient nurse staffing may be important to reduce postsurgical in-hospital fractures in acute care hospitals.

SUBMITTER: Morita K

PROVIDER: S-EPMC5441478 | biostudies-other | 2017 Jun

REPOSITORIES: biostudies-other

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Association between Nurse Staffing and In-Hospital Bone Fractures: A Retrospective Cohort Study.

Morita Kojiro K Matsui Hiroki H Fushimi Kiyohide K Yasunaga Hideo H

Health services research 20160724 3

<h4>Objective</h4>To determine if sufficient nurse staffing reduced in-hospital fractures in acute care hospitals.<h4>Data sources/study setting</h4>The Japanese Diagnosis Procedure Combination inpatient (DPC) database from July 2010 to March 2014 linked with the Surveys for Medical Institutions.<h4>Study design</h4>We conducted a retrospective cohort study to examine the association of inpatient nurse-to-occupied bed ratio (NBR) with in-hospital fractures. Multivariable logistic regression with ...[more]

PMID: 27453490

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Project description:OBJECTIVES:Omissions and delays in delivering nursing care are widely reported consequences of staffing shortages, with potentially serious impacts on patients. However, studies so far have relied almost exclusively on nurse self-reporting. Monitoring vital signs is a key part of nursing work and electronic recording provides an opportunity to objectively measure delays in care. This study aimed to determine the association between registered nurse (RN) and nursing assistant (NA) staffing levels and adherence to a vital signs monitoring protocol. DESIGN:Retrospective observational study. SETTING:32 medical and surgical wards in an acute general hospital in England. PARTICIPANTS:538 238 nursing shifts taken over 30 982 ward days. PRIMARY AND SECONDARY OUTCOME MEASURES:Vital signs observations were scheduled according to a protocol based on the National Early Warning Score (NEWS). The primary outcome was the daily rate of missed vital signs (overdue by ?67% of the expected time to next observation). The secondary outcome was the daily rate of late vital signs observations (overdue by ?33%). We undertook subgroup analysis by stratifying observations into low, medium and high acuity using NEWS. RESULTS:Late and missed observations were frequent, particularly in high acuity patients (median=44%). Higher levels of RN staffing, measured in hours per patient per day (HPPD), were associated with a lower rate of missed observations in all (IRR 0.983, 95% CI 0.979 to 0.987) and high acuity patients (0.982, 95% CI 0.972 to 0.992). However, levels of NA staffing were only associated with the daily rate (0.954, CI 0.949 to 0.958) of all missed observations. CONCLUSIONS:Adherence to vital signs monitoring protocols is sensitive to levels of nurse and NA staffing, although high acuity observations appeared unaffected by levels of NAs. We demonstrate that objectively measured omissions in care are related to nurse staffing levels, although the absolute effects are small. STUDY REGISTRATION:The data and analyses presented here were part of the larger Missed Care study (ISRCTN registration: 17930973).

Project description:ObjectiveThe objective of this study was to addresses the basic question of whether alternative legislative approaches are effective in encouraging hospitals to increase nurse staffing.MethodsUsing 16 years of nationally representative hospital-level data from the American Hospital Association (AHA) annual survey, we employed a difference-in-difference design to compare changes in productive hours per patient day for registered nurses (RNs), licensed practical/vocational nurses (LPNs), and nursing assistive personnel (NAP) in the state that mandated staffing ratios, states that legislated staffing committees, and states that legislated public reporting, to changes in states that did not implement any nurse staffing legislation before and after the legislation was implemented. We constructed multivariate linear regression models to assess the effects with hospital and year fixed effects, controlling for hospital-level characteristics and state-level factors.ResultsCompared with states with no legislation, the state that legislated minimum staffing ratios had an 0.996 (P<0.01) increase in RN hours per patient day and 0.224 (P<0.01) increase in NAP hours after the legislation was implemented, but no statistically significant changes in RN or NAP hours were found in states that legislated a staffing committee or public reporting. The staffing committee approach had a negative effect on LPN hours (difference-in-difference=-0.076, P<0.01), while the public reporting approach had a positive effect on LPN hours (difference-in-difference=0.115, P<0.01). There was no statistically significant effect of staffing mandate on LPN hours.ConclusionsWhen we included California in the comparison, our model suggests that neither the staffing committee nor the public reporting approach alone are effective in increasing hospital RN staffing, although the public reporting approach appeared to have a positive effect on LPN staffing. When we excluded California form the model, public reporting also had a positive effect on RN staffing. Future research should examine patient outcomes associated with these policies, as well as potential cost savings for hospitals from reduced nurse turnover rates.

Dataset Information

Association between Nurse Staffing and In-Hospital Bone Fractures: A Retrospective Cohort Study.

Publications

Association between Nurse Staffing and In-Hospital Bone Fractures: A Retrospective Cohort Study.

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