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The association between nurse staffing and hospital outcomes in injured patients
BACKGROUND: The enormous fiscal pressures facing trauma centers may lead trauma centers to reduce nurse staffing and to make increased use of less expensive and less skilled personnel. The impact of nurse staffing and skill mix on trauma outcomes has not been previously reported. The goal of this st...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444311/ https://www.ncbi.nlm.nih.gov/pubmed/22876839 http://dx.doi.org/10.1186/1472-6963-12-247 |
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author | Glance, Laurent G Dick, Andrew W Osler, Turner M Mukamel, Dana B Li, Yue Stone, Patricia W |
author_facet | Glance, Laurent G Dick, Andrew W Osler, Turner M Mukamel, Dana B Li, Yue Stone, Patricia W |
author_sort | Glance, Laurent G |
collection | PubMed |
description | BACKGROUND: The enormous fiscal pressures facing trauma centers may lead trauma centers to reduce nurse staffing and to make increased use of less expensive and less skilled personnel. The impact of nurse staffing and skill mix on trauma outcomes has not been previously reported. The goal of this study was to examine whether nurse staffing levels and nursing skill mix are associated with trauma patient outcomes. METHODS: We used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to perform a cross-sectional study of 70,142 patients admitted to 77 Level I and Level II centers. Logistic regression models were used to examine the association between nurse staffing measures and (1) mortality, (2) healthcare associated infections (HAI), and (3) failure-to-rescue. We controlled for patient risk factors (age, gender, injury severity, mechanism of injury, comorbidities) and hospital structural characteristics (trauma center status - Level I versus Level II, hospital size, ownership, teaching status, technology level, and geographic region). RESULTS: A 1% increase in the ratio of licensed practical nurse (LPN) to total nursing time was associated with a 4% increase in the odds of mortality (adj OR 1.04; 95% CI: 1.02-1.06; p = 0.001) and a 6% increase in the odds of sepsis (adj OR 1.06: 1.03-1.10; p < 0.001). Hospitals in the highest quartile of LPN staffing had 3 excess deaths (95% CI: 1.2, 5.1) and 5 more episodes of sepsis (95% CI: 2.3, 7.6) per 1000 patients compared to hospitals in the lower quartile of LPN staffing. CONCLUSIONS: Higher hospital LPN staffing levels are independently associated with slightly higher rates of mortality and sepsis in trauma patients admitted to Level I or Level II trauma centers. |
format | Online Article Text |
id | pubmed-3444311 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-34443112012-09-20 The association between nurse staffing and hospital outcomes in injured patients Glance, Laurent G Dick, Andrew W Osler, Turner M Mukamel, Dana B Li, Yue Stone, Patricia W BMC Health Serv Res Research Article BACKGROUND: The enormous fiscal pressures facing trauma centers may lead trauma centers to reduce nurse staffing and to make increased use of less expensive and less skilled personnel. The impact of nurse staffing and skill mix on trauma outcomes has not been previously reported. The goal of this study was to examine whether nurse staffing levels and nursing skill mix are associated with trauma patient outcomes. METHODS: We used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to perform a cross-sectional study of 70,142 patients admitted to 77 Level I and Level II centers. Logistic regression models were used to examine the association between nurse staffing measures and (1) mortality, (2) healthcare associated infections (HAI), and (3) failure-to-rescue. We controlled for patient risk factors (age, gender, injury severity, mechanism of injury, comorbidities) and hospital structural characteristics (trauma center status - Level I versus Level II, hospital size, ownership, teaching status, technology level, and geographic region). RESULTS: A 1% increase in the ratio of licensed practical nurse (LPN) to total nursing time was associated with a 4% increase in the odds of mortality (adj OR 1.04; 95% CI: 1.02-1.06; p = 0.001) and a 6% increase in the odds of sepsis (adj OR 1.06: 1.03-1.10; p < 0.001). Hospitals in the highest quartile of LPN staffing had 3 excess deaths (95% CI: 1.2, 5.1) and 5 more episodes of sepsis (95% CI: 2.3, 7.6) per 1000 patients compared to hospitals in the lower quartile of LPN staffing. CONCLUSIONS: Higher hospital LPN staffing levels are independently associated with slightly higher rates of mortality and sepsis in trauma patients admitted to Level I or Level II trauma centers. BioMed Central 2012-08-09 /pmc/articles/PMC3444311/ /pubmed/22876839 http://dx.doi.org/10.1186/1472-6963-12-247 Text en Copyright ©2012 Glance et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Glance, Laurent G Dick, Andrew W Osler, Turner M Mukamel, Dana B Li, Yue Stone, Patricia W The association between nurse staffing and hospital outcomes in injured patients |
title | The association between nurse staffing and hospital outcomes in injured patients |
title_full | The association between nurse staffing and hospital outcomes in injured patients |
title_fullStr | The association between nurse staffing and hospital outcomes in injured patients |
title_full_unstemmed | The association between nurse staffing and hospital outcomes in injured patients |
title_short | The association between nurse staffing and hospital outcomes in injured patients |
title_sort | association between nurse staffing and hospital outcomes in injured patients |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444311/ https://www.ncbi.nlm.nih.gov/pubmed/22876839 http://dx.doi.org/10.1186/1472-6963-12-247 |
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