Abstract
BackgroundThe likelihood of inpatient mortality has been found to be reduced by increased nurse staffing in several settings, including general wards, emergency departments, and intensive care units. However, less research has investigated cases where patients die in the community setting due to a health problem that occurred after they were discharged post-surgery, because it is difficult to integrate hospital data and local community data. Therefore, this study investigated the association between the bed-to-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery using national administrative data.MethodsThe study analyzed data from 129,923 patients who underwent surgery between January 2014 and December 2015. The bed-to-nurse ratio was categorized as level 1 (less than 2.5), level 2 (2.5–3.4), level 3 (3.5–4.4), and level 4 (4.5 or greater). The chi-square test and GEE logistic regression analyses were used to explore the association between the bed-to-nurse ratio and 30-day post-discharge mortality.Results1355 (0.01%) patients died within 30 days post-discharge. The 30-day post-discharge mortality rate in hospitals with a level 4 was 2.5%, representing a statistically significant difference from the rates of 0.8, 2 and 1.8% in hospitals with level 1, level 2, and level 3 staffing, respectively. In addition, the death rate was significantly lower at hospitals with a level 1 (OR = 0.62) or level 2 (OR = 0.63) bed-to-nurse ratio, using level 4 as reference.ConclusionThe results of this study are highly meaningful in that they underscore the necessity of in-hospital discharge nursing and continued post-discharge nursing care as a way to reduce post-discharge mortality risk. Furthermore, the relationship between nurse staffing levels and 30-day post-discharge mortality implies the need for a greater focus on discharge education. Policies are required to achieve proper nurse staffing levels in Korea, and thereby to enhance patient outcomes.
Highlights
The likelihood of inpatient mortality has been found to be reduced by increased nurse staffing in several settings, including general wards, emergency departments, and intensive care units
Studies of the associations between inpatient or postdischarge patient mortality and nurse staffing for patients with various conditions—treated medically or surgically—have been conducted in many countries, and the likelihood of patient mortality has been found to be reduced by increased nurse staffing in several settings, including general wards, emergency departments, and intensive care units (ICU) [5,6,7,8]
The 12 types of surgery analyzed in this study were determined using Korean Diagnosis-Related Group (KDRG) categories with relatively high death rates according to previous studies
Summary
The likelihood of inpatient mortality has been found to be reduced by increased nurse staffing in several settings, including general wards, emergency departments, and intensive care units. Less research has investigated cases where patients die in the community setting due to a health problem that occurred after they were discharged post-surgery, because it is difficult to integrate hospital data and local community data. Many studies have investigated these patient outcomes, less research has investigated cases where patients die in the community setting, such as at home or a nursing home without appropriate safeguards, due to a health problem that occurred after they were discharged post-surgery. This gap in the literature exists because it is difficult to integrate hospital data and local community data. For this reason, based on previous studies showing associations between patient mortality and nurse staffing, this study expands the existing evidence by linking nurse staffing to post-discharge death in patients who underwent surgery
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