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Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study

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Post-operative mortality, missed care and nurse staffing in nine countries : a cross-sectional study. / Ball, Jane E.; Bruyneel, Luk; Aiken, Linda H.; Sermeus, Walter; Sloane, Douglas M.; Rafferty, Anne Marie; Lindqvist, Rikard; Tishelman, Carol; Griffiths, Peter.

In: International Journal of Nursing Studies, 24.08.2017.

Research output: Contribution to journalArticle

Harvard

Ball, JE, Bruyneel, L, Aiken, LH, Sermeus, W, Sloane, DM, Rafferty, AM, Lindqvist, R, Tishelman, C & Griffiths, P 2017, 'Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study', International Journal of Nursing Studies. https://doi.org/10.1016/j.ijnurstu.2017.08.004

APA

Ball, J. E., Bruyneel, L., Aiken, L. H., Sermeus, W., Sloane, D. M., Rafferty, A. M., ... Griffiths, P. (2017). Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study. International Journal of Nursing Studies. https://doi.org/10.1016/j.ijnurstu.2017.08.004

Vancouver

Ball JE, Bruyneel L, Aiken LH, Sermeus W, Sloane DM, Rafferty AM et al. Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study. International Journal of Nursing Studies. 2017 Aug 24. https://doi.org/10.1016/j.ijnurstu.2017.08.004

Author

Ball, Jane E. ; Bruyneel, Luk ; Aiken, Linda H. ; Sermeus, Walter ; Sloane, Douglas M. ; Rafferty, Anne Marie ; Lindqvist, Rikard ; Tishelman, Carol ; Griffiths, Peter. / Post-operative mortality, missed care and nurse staffing in nine countries : a cross-sectional study. In: International Journal of Nursing Studies. 2017.

Bibtex Download

@article{aedb0d6fd3e849f4a4523f19db5df14d,
title = "Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study",
abstract = "Background Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery. Aim Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality. Method Data from the RN4CAST study (2009-2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses’ staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation. Results Nurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse’s workload by one patient and a 10{\%} increase in the percent of missed nursing care were associated with a 7{\%} (OR 1.068, 95{\%} CI 1.031-1.106) and 16{\%} (OR 1·159 95{\%} CI 1·039-1·294) increase in the odds of a patient dying within 30 days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality. Conclusion Missed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an ‘early warning’ indicator of higher risk for poor patient outcomes.",
keywords = "patient safety, nurse staffing, mortality, post-surgical, hospital, care left undone, missed care, cross-sectional study, mediation",
author = "Ball, {Jane E.} and Luk Bruyneel and Aiken, {Linda H.} and Walter Sermeus and Sloane, {Douglas M.} and Rafferty, {Anne Marie} and Rikard Lindqvist and Carol Tishelman and Peter Griffiths",
year = "2017",
month = "8",
day = "24",
doi = "10.1016/j.ijnurstu.2017.08.004",
language = "English",
journal = "International Journal of Nursing Studies",
issn = "0020-7489",
publisher = "Elsevier Limited",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Post-operative mortality, missed care and nurse staffing in nine countries

T2 - a cross-sectional study

AU - Ball, Jane E.

AU - Bruyneel, Luk

AU - Aiken, Linda H.

AU - Sermeus, Walter

AU - Sloane, Douglas M.

AU - Rafferty, Anne Marie

AU - Lindqvist, Rikard

AU - Tishelman, Carol

AU - Griffiths, Peter

PY - 2017/8/24

Y1 - 2017/8/24

N2 - Background Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery. Aim Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality. Method Data from the RN4CAST study (2009-2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses’ staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation. Results Nurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse’s workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% (OR 1.068, 95% CI 1.031-1.106) and 16% (OR 1·159 95% CI 1·039-1·294) increase in the odds of a patient dying within 30 days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality. Conclusion Missed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an ‘early warning’ indicator of higher risk for poor patient outcomes.

AB - Background Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery. Aim Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality. Method Data from the RN4CAST study (2009-2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses’ staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation. Results Nurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse’s workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% (OR 1.068, 95% CI 1.031-1.106) and 16% (OR 1·159 95% CI 1·039-1·294) increase in the odds of a patient dying within 30 days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality. Conclusion Missed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an ‘early warning’ indicator of higher risk for poor patient outcomes.

KW - patient safety

KW - nurse staffing

KW - mortality

KW - post-surgical

KW - hospital

KW - care left undone

KW - missed care

KW - cross-sectional study

KW - mediation

U2 - 10.1016/j.ijnurstu.2017.08.004

DO - 10.1016/j.ijnurstu.2017.08.004

M3 - Article

JO - International Journal of Nursing Studies

JF - International Journal of Nursing Studies

SN - 0020-7489

ER -

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