This article has been deemed an “Instant Classic” by AHRQ’s Patient Safety Net. This should be pushed out to nursing staff.

N Engl J Med. 2011 Mar 17;364(11):1037-45.
Nurse staffing and inpatient hospital mortality.

Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M.

Department of Health Services, University of California, Los Angeles, School of Public Health, Los Angeles, USA.
Abstract

BACKGROUND: Cross-sectional studies of hospital-level administrative data have shown an association between lower levels of staffing of registered nurses (RNs) and increased patient mortality. However, such studies have been criticized because they have not shown a direct link between the level of staffing and individual patient experiences and have not included sufficient statistical controls.

METHODS: We used data from a large tertiary academic medical center involving 197,961 admissions and 176,696 nursing shifts of 8 hours each in 43 hospital units to examine the association between mortality and patient exposure to nursing shifts during which staffing by RNs was 8 hours or more below the staffing target. We also examined the association between mortality and high patient turnover owing to admissions, transfers, and discharges. We used Cox proportional-hazards models in the analyses with adjustment for characteristics of patients and hospital units.

RESULTS: Staffing by RNs was within 8 hours of the target level for 84% of shifts, and patient turnover was within 1 SD of the day-shift mean for 93% of shifts. Overall mortality was 61% of the expected rate for similar patients on the basis of modified diagnosis-related groups. There was a significant association between increased mortality and increased exposure to unit shifts during which staffing by RNs was 8 hours or more below the target level (hazard ratio per shift 8 hours or more below target, 1.02; 95% confidence interval [CI], 1.01 to 1.03; P<0.001). The association between increased mortality and high patient turnover was also significant (hazard ratio per high-turnover shift, 1.04; 95% CI, 1.02 to 1.06; P<0.001).

CONCLUSIONS: In this retrospective observational study, staffing of RNs below target levels was associated with increased mortality, which reinforces the need to match staffing with patients’ needs for nursing care. (Funded by the Agency for Healthcare Research and Quality.).

PMID: 21410372 [PubMed - indexed for MEDLINE]

On the right side of the screen see “Read the Report Online for Free” and review “Chapter 4 Standards for Synthesizing the Body of Evidence (123-154)”. It has great information on useful resources to use when conducting searches. Remember that Hospital policies and procedures should be thought of as mini-systematic reviews.

Also it says:

“A librarian or other qualified information specialist with training or experience in conducting SRs should work with the SR team to design the search strategy to ensure appropriate translation of the research question into search concepts, correct Boolean operators and line numbers, appropriate application and spelling of terms” (Sampson and McGowan, 2006).

“Expert guidance recommends that an experience library or information specialist with training in SR search methods should also be involved in performing the search” (CRD, 2009; McGowan and Sampson, 2005; Lefebvre et al., 2008; Relevo and Balshem, 2011).

Julie Esparza – thx to Lorri Zipperer for posting.