title: The relationship between nurse staffing and failure to rescue: where does it matter most?
abstract: OBJECTIVE
  This study further expands on the relationship between nurse staffing levels and patient outcomes, in particular, failure to rescue. Many studies are based on single-site hospitals or single-year data, thus limiting the generalizations of the findings. The purpose was to evaluate in a multisite multiyear study the relationship between unit-level nurse staffing and FTR mortality, for ICU and non-ICU patients.
  
  
  METHODS
  Using administrative and actual unit level nurse staffing data, we used AHRQ 2003 Patient Safety Indicator (2003) software and matched those with the patient's discharge month. Fixed effects multilevel logistic analyses were used to take into account the hierarchical structure of the database and patient clustering within units. We controlled for patient demographics, clinical conditions, and CCS categories.
  
  
  RESULTS
  The majority (94%) of cases were discharged from general care units, ICUs reported higher nurse staffing levels based on patient complexity. Expired cases were 3 years older, male, and nonwhite. For general care discharges, the relationship between RN level HPPD approached significance (P = 0.07), suggesting increased odds of higher FTR mortality with higher staffing levels.
  
  
  CONCLUSIONS
  We did not observe any of the expected associations between the nurse staffing variables and FTR for either general care unit or ICU discharges. The comprehensive risk adjustments provided adequate "leveling of the playing field" to evaluate the impact of unit-based nurse staffing levels on FTR mortality. Future studies should evaluate the influence of unit environment and patient risk.
authors.affiliation: From the *University of Michigan School of Medicine, Ann Arbor, Michigan; †Sarah Cole Hirsh Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio; ‡New Jersey; and §University of Michigan School of Nursing, Ann Arbor, Michigan.
authors.forename: AkkeNeel
authors.initials: A
authors.lastname: Talsma
authors.forename: Katherine
authors.initials: K
authors.lastname: Jones
authors.forename: Ying
authors.initials: Y
authors.lastname: Guo
authors.forename: Deleise
authors.initials: D
authors.lastname: Wilson
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000592:standards; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D000078329:Workforce