Nurse staffing and postsurgical adverse events: an analysis of administrative data from a sample of U.S. hospitals, 1990-1996.
OBJECTIVE
To examine the impact of nurse staffing on selected adverse events hypothesized to be sensitive to nursing care between 1990 and 1996, after controlling for hospital characteristics.


METHODS
The yearly cross-sectional samples of hospital discharges for states participating in the National Inpatient Sample (NIS) from 1990-1996 were combined to form the analytic sample. Six states were included for 1990-1992, four states were added for the period 1993-1994, and three additional states were added in 1995-1996.


METHODS
The study design was cross-sectional descriptive.


METHODS
Data for patients aged 18 years and older who were discharged between 1990 and 1996 were used to create hospital-level adverse event indicators. Hospital-level adverse event data were defined by quality indicators developed by the Health Care Utilization Project (HCUP). These data were matched to American Hospital Association (AHA) data on community hospital characteristics, including registered nurse (RN) and licensed practical/vocational nurse (LPN) staffing hours, to examine the relationship between nurse staffing and four postsurgical adverse events: venous thrombosis/pulmonary embolism, pulmonary compromise after surgery, urinary tract infection, and pneumonia. Multivariate modeling using Poisson regression techniques was used.


RESULTS
An inverse relationship was found between RN hours per adjusted inpatient day and pneumonia (p < .05) for routine and emergency patient admissions.


CONCLUSIONS
The inverse relationship between pneumonia and nurse staffing are consistent with previous findings in the literature. The results provide additional evidence for health policy makers to consider when making decisions about required staffing levels to minimize adverse events.
Division of Nursing, School of Education, New York University, New York 10003-6677, USA.
Christine
C
Kovner
Cheryl
C
Jones
Chunliu
C
Zhan
Peter J
PJ
Gergen
Jayasree
J
Basu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009722:Nurse Practitioners / Q000600:supply & distribution; D015401:Nursing Administration Research; D009732:Nursing Care / Q000592:standards*; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D011014:Pneumonia / Q000209:etiology / Q000451:nursing; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000451:nursing*; D011655:Pulmonary Embolism / Q000209:etiology / Q000451:nursing; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000209:etiology / Q000451:nursing; D020246:Venous Thrombosis / Q000209:etiology / Q000451:nursing