Nurse staffing and mortality in stroke centers

August 19, 2014, Public Library of Science

Hospital staffing levels have been associated with patient outcomes, but staffing on weekends has not been well studied, despite a recent UK mandate to make physician specialist care 7 days a week a policy and service improvement priority for the National Health Service. To help address the paucity of research on the association of weekend staffing with patient outcomes, Dr. Benjamin Bray of King's College London and Royal College of Physicians, United Kingdom, and colleagues conducted a prospective cohort study of weekend staffing with stroke specialist physicians for patients admitted to 103 stroke units in England, published in this issue of PLOS Medicine.

Bray and colleagues analyzed data from 56,666 patients with admitted between 1 June 2011 and 1 December 2012, collected for a national register of stroke care in England. They found that of patients admitted to a stroke service, patient did not differ whether stroke specialist physician rounds were 7 days per week or fewer than 7 days per week. However, when Bray and colleagues evaluated ratios, they found that patients admitted to hospitals with the lowest weekend ratios of registered nurses to patient beds had the highest mortality risk. Weekend nurse staffing was also closely correlated with nurse staffing during the week. After confounding factors were adjusted for, patients admitted to a stroke unit with 1.5 registered nurses/ten beds had an estimated adjusted 30-d mortality risk of 15.2% compared to 11.2% for patients admitted to a unit with 3.0 nurses/ten beds, equivalent to one excess death per 25 admissions. The authors acknowledge that because the study is observational, there could be unmeasured characteristics of stroke services that differ between groups.

The authors interpret these results: "The lack of an association of mortality with daily physician ward rounds might be explained by the observation that the majority of units not providing rounds 7 d/wk instead had rounds 5 d/wk: the difference in patients' exposure to the frequency of physician rounds was therefore small. By contrast, weekend nursing ratios were strongly associated with mortality outcomes, not only for patients admitted on a weekend but also for those admitted on a weekday."

They conclude, "Controlled studies of different models of physician and nursing staffing seem both feasible and important, given the potentially large impact on and the high costs to health systems of increasing staffing levels on weekends. In the meantime, these data support the provision of higher weekend registered nurse/bed ratios in [stroke units]."

According to Meeta Prasad Kerlin (Perelman School of Medicine at the University of Pennsylvania), author of an accompanying Perspective, few rigorous studies have evaluated the association of weekend and evening staffing with patient outcomes, and most research to date has addressed physician staffing. However, prior research has found that higher nurse staffing levels are associated with better patient outcomes. Despite this evidence, there have been no randomized trials to establish definitively that increasing the number of nurses caring for patients can improve outcomes, such as would be required for other non-organizational interventions. Kerlin says, "Knowing that nurses are in short supply, and that their greater presence is beneficial, the next steps must be taken to understand how best to allocate the limited workforce and what creative solutions can mitigate the effects of different staffing levels."

Explore further: Low Intensive Care Unit staffing levels affect patient survival

More information: Bray BD, Ayis S, Campbell J, Cloud GC, James M, et al. (2014) Associations between Stroke Mortality and Weekend Working by Stroke Specialist Physicians and Registered Nurses: Prospective Multicentre Cohort Study. PLoS Med 11(8): e1001705. DOI: 10.1371/journal.pmed.1001705

Related Stories

Low Intensive Care Unit staffing levels affect patient survival

April 2, 2014
Patients in Intensive Care have a better chance of survival if there are more doctors and nurses working on the unit, new research shows.

California nurse staffing

July 15, 2011
In a comprehensive analysis comparing nurse staffing in California hospitals to similar hospitals in the U.S. over nearly a decade, researchers at the University of Pennsylvania School of Nursing have found that controversial ...

More nurses for hospital patients: Impact on quality questionable

September 12, 2012
Passage of a bill in 1999 requiring minimum nurse-to-patient ratios in California hospitals increased the number of nurses but resulted in mixed quality of care, according to a new study in the journal Health Services Research.

Study of 55 million people adds further evidence that patients admitted to hospital at weekends have higher mortality

June 1, 2014
A systematic review and meta-analysis of hospital data worldwide, presented as this year's Euroanaesthesia meeting in Stockholm, adds further evidence that patients admitted to hospital at weekends have higher mortality than ...

Hospital nurse staffing tied to readmissions penalties

October 15, 2013
(HealthDay)—Hospitals with higher nurse staffing have lower odds of Medicare readmissions penalties than hospitals with lower staffing, according to a study published in the October issue of Health Affairs.

Nurse staffing ratios affect hospital readmissions for children with common conditions

May 8, 2013
A new study shows that pediatric nurse staffing ratios are significantly associated with hospital readmission for children with common medical and surgical conditions.

Recommended for you

Early studies of male birth-control pill show promise

March 23, 2018
Well, well, well. The ball has been knocked roundly into your court, gentlemen.

Whether sustained or sporadic, exercise offers same reductions in death risk

March 22, 2018
For decades, Americans have been inundated with a confusing barrage of messages about how best to counteract the health risks of sedentary lifestyles: walk 10,000 steps a day; do a seven-minute workout from a phone app; flip ...

Tai chi as good as or better than aerobic exercise for managing chronic pain

March 21, 2018
The ancient martial art of tai chi has similar or greater benefits than aerobic exercise for people with the chronic pain condition fibromyalgia, finds a trial published by The BMJ today.

Study: Poor health is a less common cause of bankruptcy than commonly thought, but it brings other economic woes

March 21, 2018
A team of researchers led by an MIT economist has found that medical expenses account for roughly 4 percent of bankruptcy filings among nonelderly adults in the U.S.

Study finds bad sleep habits start early in school-age children

March 21, 2018
Bad sleep habits in children begin earlier than many experts assume. That's the takeaway from a new study led by McGill University researchers. The findings suggest that official sleep guidelines for young school children ...

Medical expansion has improved health—with one exception

March 21, 2018
While Americans debate the rising cost of health care, a new study of 30 countries over 27 years found that medical expansion has improved overall health - with one major exception.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.