Abstract
BackgroundRecent ecological studies have suggested that inadequate nurse staffing may contribute to the incidence of adverse events in acute care hospitals. However, longitudinal studies are needed to further examine these associations and to identify the staffing patterns that are of greatest risk. The aims of this study are to determine if (a) nurse staffing levels are associated with an increased risk of adverse events, (b) the risk of adverse events in relationship to nurse staffing levels is modified by the complexity of patient requirements, and (c) optimal nurse staffing levels can be established.Methods/designA dynamic cohort of all adult medical, surgical, and intensive care unit patients admitted between 2010 and 2015 to a Canadian academic health center will be followed during the inpatient and 7-day post-discharge period to assess the occurrence and frequency of adverse events in relationship to antecedent nurse staffing levels. Four potentially preventable adverse events will be measured: (a) hospital-acquired pneumonia, (b) ventilator-associated pneumonia, (c) venous thromboembolism, and (d) in-hospital fall. These events were selected for their high incidence, morbidity and mortality rates, and because they are hypothesized to be related to nurse staffing levels. Adverse events will be ascertained from electronic health record data using validated automated detection algorithms. Patient exposure to nurse staffing will be measured on every shift of the hospitalization using electronic payroll records. To examine the association between nurse staffing levels and the risk of adverse events, four Cox proportional hazards regression models will be used (one for each adverse event), while adjusting for patient characteristics and risk factors of adverse event occurrence. To determine if the association between nurse staffing levels and the occurrence of adverse events is modified by the complexity of patient requirements, interaction terms will be included in the regression models, and their significance assessed. To assess for the presence of optimal nurse staffing levels, flexible nonlinear spline functions will be fitted.DiscussionThis study will likely generate evidence-based information that will assist managers in making the most effective use of scarce nursing resources and in identifying staffing patterns that minimize the risk of adverse events.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0278-1) contains supplementary material, which is available to authorized users.
Highlights
Recent ecological studies have suggested that inadequate nurse staffing may contribute to the incidence of adverse events in acute care hospitals
This study will likely generate evidence-based information that will assist managers in making the most effective use of scarce nursing resources and in identifying staffing patterns that minimize the risk of adverse events
It has been difficult to translate the results of these studies into specific recommendations regarding the optimal nurse staffing levels for a given patient at a specific point in time during the course of a hospitalization [13, 15]. To move this field forward, there is a need for longitudinal studies conducted at the patient level of analysis [16]. Such studies are required to determine if nurse staffing levels are related to Adverse event (AE) and to identify the particular staffing patterns that are of greatest risk, and the specific staffing thresholds that minimize the risk of AEs given the complexity of patient requirements
Summary
Recent ecological studies have suggested that inadequate nurse staffing may contribute to the incidence of adverse events in acute care hospitals. AEs affect between 2.9 and 16.6 % of all hospitalized patients, and studies have estimated that 30 to 58 % of all AEs are preventable [2,3,4,5,6,7,8,9]. Preventable AEs are very costly, representing between US$17 and US$29 billion in additional health care costs annually [4]. Human errors have been identified as one of the largest contributors to the occurrence of preventable AEs in acute care hospitals [1, 10]. Nurses are the largest component of the acute care hospital workforce, representing 30 to 40 % of hospital staff, accounting for 25 % of the total acute care hospital operating budget and 44 % of direct care costs [11, 12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
