Longitudinal analyses of nurse staffing and patient outcomes: more about failure to rescue.
BACKGROUND
Numerous studies have examined cross-sectional data to determine the relationships between nurse staffing and patient outcomes. Questions have been raised about some of the studies now in the literature regarding the use of the hospital as the unit of analysis and the cross-sectional design of the studies. Additionally, there is a concern that the primary outcomes being studied are negative.


OBJECTIVE
Objectives of this study are to (1) compare the relationships between nurse staffing and positive patient outcomes for 3 adult medical-surgical nursing units in one university teaching hospital across 4 years (16 fiscal quarters); and (2) explore the use of 2 new failure-to-rescue (FTR) rates as outcomes, specifically FTR from medication errors and FTR from decubitus ulcers.


METHODS
This study uses secondary analyses of data viewed retrospectively with a longitudinal repeated-measures design to estimate the relationships between nurse staffing and the outcomes of interest.


RESULTS
Accounting for total dollars and case mix, all patient satisfaction measures increased as total hours of care per patient day increased, and as the skill mix became richer (more RN hours/total hours) there was a higher satisfaction with pain management and physical care requests. There was an increase in FTR from medication error as the non-RN (Other) hours of care per patient day increased and there was an increase in FTR from decubitus ulcers as patient severity increased.


CONCLUSIONS
The overall conclusion is that it will likely be necessary to vary staffing hours and staffing mix depending on which positive patient outcome or outcomes you wish to achieve.
Seago
Jean Ann
JA
University of California, San Francisco, Calif 94143-0608, USA. jean.ann.seago@nursing.ucsf.edu
Williamson
Ann
A
Atwood
Christina
C
D000328:Adult; D003625:Data Collection / Q000379:methods; D006801:Humans; D008137:Longitudinal Studies; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D008962:Models, Theoretical; D009732:Nursing Care / Q000592:standards*; D015403:Nursing Evaluation Research / Q000379:methods; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction; D010561:Personnel Staffing and Scheduling; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States